|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
IP
|
$2.35
|
|
|
Service Code
|
NDC 65162-087-74
|
| Hospital Charge Code |
1715991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.61
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 31722-006-31
|
| Hospital Charge Code |
1715991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.37
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
OP
|
$11.36
|
|
|
Service Code
|
NDC 55513-800-60
|
| Hospital Charge Code |
ERX204605
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Adventist Health Commercial |
$2.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.67
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.66
|
| Rate for Payer: Dignity Health Senior |
$9.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.03
|
| Rate for Payer: Heritage Provider Network Senior |
$7.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$8.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.66
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
IP
|
$11.36
|
|
|
Service Code
|
NDC 55513-800-60
|
| Hospital Charge Code |
ERX204605
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Adventist Health Commercial |
$2.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.80
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.69
|
| Rate for Payer: Heritage Provider Network Senior |
$7.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$8.52
|
|
|
IVABRADINE 7.5 MG TABLET [204608]
|
Facility
OP
|
$11.36
|
|
|
Service Code
|
NDC 55513-810-60
|
| Hospital Charge Code |
ERX204608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Adventist Health Commercial |
$2.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.67
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.66
|
| Rate for Payer: Dignity Health Senior |
$9.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.03
|
| Rate for Payer: Heritage Provider Network Senior |
$7.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$8.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.66
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
|
IVABRADINE 7.5 MG TABLET [204608]
|
Facility
IP
|
$11.36
|
|
|
Service Code
|
NDC 55513-810-60
|
| Hospital Charge Code |
ERX204608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Adventist Health Commercial |
$2.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.80
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.69
|
| Rate for Payer: Heritage Provider Network Senior |
$7.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$8.52
|
|
|
IVERMECTIN 0.5 % LOTION [196318]
|
Facility
OP
|
$2.79
|
|
|
Service Code
|
NDC 24338-183-04
|
| Hospital Charge Code |
NDG196318
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1.73
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.37
|
| Rate for Payer: Dignity Health Senior |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
IVERMECTIN 0.5 % LOTION [196318]
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
NDC 24338-183-04
|
| Hospital Charge Code |
NDG196318
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.92
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
|
|
IVERMECTIN 3 MG TABLET [25820]
|
Facility
OP
|
$4.97
|
|
|
Service Code
|
NDC 42799-806-01
|
| Hospital Charge Code |
1712490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.92
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.22
|
| Rate for Payer: Dignity Health Senior |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.08
|
| Rate for Payer: Heritage Provider Network Senior |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$3.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.22
|
|
|
IVERMECTIN 3 MG TABLET [25820]
|
Facility
IP
|
$4.97
|
|
|
Service Code
|
NDC 42799-806-01
|
| Hospital Charge Code |
1712490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.41
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.36
|
| Rate for Payer: Heritage Provider Network Senior |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$3.73
|
|
|
IXABEPILONE 45 MG INTRAVENOUS SOLUTION [88653]
|
Facility
OP
|
$6,645.17
|
|
|
Service Code
|
CPT J9207
|
| Hospital Charge Code |
1755731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.11 |
| Max. Negotiated Rate |
$4,983.88 |
| Rate for Payer: Adventist Health Commercial |
$1,329.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$314.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,565.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$160.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$140.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.85
|
| Rate for Payer: Blue Shield of California Commercial |
$120.11
|
| Rate for Payer: Blue Shield of California EPN |
$120.11
|
| Rate for Payer: Cash Price |
$2,990.33
|
| Rate for Payer: Cash Price |
$2,990.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,056.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.88
|
| Rate for Payer: Dignity Health Senior |
$140.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,252.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$128.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,076.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3,076.71
|
| Rate for Payer: Humana Medicare |
$128.07
|
| Rate for Payer: IEHP Medi-Cal |
$206.75
|
| Rate for Payer: IEHP Medicare Advantage |
$128.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$243.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,202.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,661.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.37
|
| Rate for Payer: Multiplan Commercial |
$4,983.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.88
|
| Rate for Payer: TriValley Medical Group Senior |
$128.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,422.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,220.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.88
|
| Rate for Payer: Vantage Medical Group Senior |
$128.07
|
|
|
IXABEPILONE 45 MG INTRAVENOUS SOLUTION [88653]
|
Facility
IP
|
$6,645.17
|
|
|
Service Code
|
CPT J9207
|
| Hospital Charge Code |
1755731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,202.78 |
| Max. Negotiated Rate |
$4,983.88 |
| Rate for Payer: Adventist Health Commercial |
$1,329.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,565.23
|
| Rate for Payer: Cash Price |
$2,990.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,056.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,588.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,498.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,498.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,202.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,661.29
|
| Rate for Payer: Multiplan Commercial |
$4,983.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,422.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,220.15
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SRA01Z
|
| Min. Negotiated Rate |
$7,368.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,368.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SRR01A
|
| Min. Negotiated Rate |
$7,368.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,175.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,368.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SWD3JZ
|
| Min. Negotiated Rate |
$8,448.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,448.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SRA0KZ
|
| Min. Negotiated Rate |
$7,368.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,175.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,368.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SRA0JZ
|
| Min. Negotiated Rate |
$7,368.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,368.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SRR07Z
|
| Min. Negotiated Rate |
$7,368.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,175.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,368.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SRF0KZ
|
| Min. Negotiated Rate |
$19,401.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SRF0JZ
|
| Min. Negotiated Rate |
$19,401.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SRA0JA
|
| Min. Negotiated Rate |
$7,368.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,368.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SRA0J9
|
| Min. Negotiated Rate |
$7,368.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,368.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SRA07Z
|
| Min. Negotiated Rate |
$7,368.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,368.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0SRA03Z
|
| Min. Negotiated Rate |
$7,368.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,368.00
|
|
|
Joint Surgery
|
Facility
IP
|
$22,635.00
|
|
|
Service Code
|
ICD 0RRK0J7
|
| Min. Negotiated Rate |
$19,401.00 |
| Max. Negotiated Rate |
$22,635.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22,635.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,401.00
|
|
