|
FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]
|
Facility
IP
|
$1.04
|
|
|
Service Code
|
NDC 65162-686-88
|
| Hospital Charge Code |
1715111
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.71
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Senior |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
|
|
FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]
|
Facility
OP
|
$2.57
|
|
|
Service Code
|
NDC 51525-0442-8
|
| Hospital Charge Code |
1715111
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.51
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.18
|
| Rate for Payer: Dignity Health Senior |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| 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 Commercial |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2.18
|
|
|
FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]
|
Facility
IP
|
$2.57
|
|
|
Service Code
|
NDC 51525-0442-8
|
| Hospital Charge Code |
1715111
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.77
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$1.93
|
|
|
FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]
|
Facility
OP
|
$9.15
|
|
|
Service Code
|
NDC 0037-0442-67
|
| Hospital Charge Code |
1715111
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.68
|
| Rate for Payer: Blue Shield of California EPN |
$5.37
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.78
|
| Rate for Payer: Dignity Health Senior |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.66
|
| Rate for Payer: Heritage Provider Network Senior |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$6.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]
|
Facility
OP
|
$0.50
|
|
|
Service Code
|
NDC 66689-825-08
|
| Hospital Charge Code |
1715111
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Senior |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]
|
Facility
IP
|
$0.50
|
|
|
Service Code
|
NDC 66689-825-08
|
| Hospital Charge Code |
1715111
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Senior |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
|
|
FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]
|
Facility
OP
|
$1.04
|
|
|
Service Code
|
NDC 65162-686-88
|
| Hospital Charge Code |
1715111
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Senior |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
|
FELBAMATE 600 MG TABLET [10025]
|
Facility
IP
|
$1.30
|
|
|
Service Code
|
NDC 62559-731-01
|
| Hospital Charge Code |
1711593
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.88
|
| Rate for Payer: Heritage Provider Network Senior |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
|
|
FELBAMATE 600 MG TABLET [10025]
|
Facility
OP
|
$1.30
|
|
|
Service Code
|
NDC 62559-731-01
|
| Hospital Charge Code |
1711593
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Senior |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
FELODIPINE ER 10 MG TABLET,EXTENDED RELEASE 24 HR [27491]
|
Facility
OP
|
$2.34
|
|
|
Service Code
|
NDC 53489-370-01
|
| Hospital Charge Code |
1712157
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.99
|
| Rate for Payer: Dignity Health Senior |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.45
|
| Rate for Payer: Heritage Provider Network Senior |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1.99
|
|
|
FELODIPINE ER 10 MG TABLET,EXTENDED RELEASE 24 HR [27491]
|
Facility
IP
|
$2.34
|
|
|
Service Code
|
NDC 53489-370-01
|
| Hospital Charge Code |
1712157
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| 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 |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
|
|
FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR [27489]
|
Facility
OP
|
$0.65
|
|
|
Service Code
|
NDC 57237-108-01
|
| Hospital Charge Code |
1712195
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.55
|
| Rate for Payer: Dignity Health Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
|
|
FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR [27489]
|
Facility
OP
|
$0.46
|
|
|
Service Code
|
NDC 68462-233-01
|
| Hospital Charge Code |
1712195
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Senior |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR [27489]
|
Facility
IP
|
$0.46
|
|
|
Service Code
|
NDC 68462-233-01
|
| Hospital Charge Code |
1712195
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
|
|
FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR [27489]
|
Facility
IP
|
$0.65
|
|
|
Service Code
|
NDC 57237-108-01
|
| Hospital Charge Code |
1712195
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
IP
|
$4,307.90
|
|
|
Service Code
|
APR-DRG 5311
|
| Min. Negotiated Rate |
$4,307.90 |
| Max. Negotiated Rate |
$4,307.90 |
| Rate for Payer: IEHP Medi-Cal |
$4,307.90
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
IP
|
$5,623.15
|
|
|
Service Code
|
APR-DRG 5312
|
| Min. Negotiated Rate |
$5,623.15 |
| Max. Negotiated Rate |
$5,623.15 |
| Rate for Payer: IEHP Medi-Cal |
$5,623.15
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
IP
|
$14,210.10
|
|
|
Service Code
|
APR-DRG 5314
|
| Min. Negotiated Rate |
$14,210.10 |
| Max. Negotiated Rate |
$14,210.10 |
| Rate for Payer: IEHP Medi-Cal |
$14,210.10
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
IP
|
$8,682.45
|
|
|
Service Code
|
APR-DRG 5313
|
| Min. Negotiated Rate |
$8,682.45 |
| Max. Negotiated Rate |
$8,682.45 |
| Rate for Payer: IEHP Medi-Cal |
$8,682.45
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
IP
|
$4,713.82
|
|
|
Service Code
|
APR-DRG 5301
|
| Min. Negotiated Rate |
$4,713.82 |
| Max. Negotiated Rate |
$4,713.82 |
| Rate for Payer: IEHP Medi-Cal |
$4,713.82
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
IP
|
$14,819.98
|
|
|
Service Code
|
APR-DRG 5304
|
| Min. Negotiated Rate |
$14,819.98 |
| Max. Negotiated Rate |
$14,819.98 |
| Rate for Payer: IEHP Medi-Cal |
$14,819.98
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
IP
|
$9,228.65
|
|
|
Service Code
|
APR-DRG 5303
|
| Min. Negotiated Rate |
$9,228.65 |
| Max. Negotiated Rate |
$9,228.65 |
| Rate for Payer: IEHP Medi-Cal |
$9,228.65
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
IP
|
$6,347.44
|
|
|
Service Code
|
APR-DRG 5302
|
| Min. Negotiated Rate |
$6,347.44 |
| Max. Negotiated Rate |
$6,347.44 |
| Rate for Payer: IEHP Medi-Cal |
$6,347.44
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
IP
|
$10,400.64
|
|
|
Service Code
|
APR-DRG 5142
|
| Min. Negotiated Rate |
$10,400.64 |
| Max. Negotiated Rate |
$10,400.64 |
| Rate for Payer: IEHP Medi-Cal |
$10,400.64
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
IP
|
$7,011.04
|
|
|
Service Code
|
APR-DRG 5141
|
| Min. Negotiated Rate |
$7,011.04 |
| Max. Negotiated Rate |
$7,011.04 |
| Rate for Payer: IEHP Medi-Cal |
$7,011.04
|
|
