|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
IP
|
$6,440.96
|
|
|
Service Code
|
APR-DRG 8922
|
| Min. Negotiated Rate |
$6,440.96 |
| Max. Negotiated Rate |
$6,440.96 |
| Rate for Payer: IEHP Medi-Cal |
$6,440.96
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
IP
|
$7,609.96
|
|
|
Service Code
|
APR-DRG 8902
|
| Min. Negotiated Rate |
$7,609.96 |
| Max. Negotiated Rate |
$7,609.96 |
| Rate for Payer: IEHP Medi-Cal |
$7,609.96
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
IP
|
$21,692.71
|
|
|
Service Code
|
APR-DRG 8904
|
| Min. Negotiated Rate |
$21,692.71 |
| Max. Negotiated Rate |
$21,692.71 |
| Rate for Payer: IEHP Medi-Cal |
$21,692.71
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
IP
|
$7,228.92
|
|
|
Service Code
|
APR-DRG 8901
|
| Min. Negotiated Rate |
$7,228.92 |
| Max. Negotiated Rate |
$7,228.92 |
| Rate for Payer: IEHP Medi-Cal |
$7,228.92
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
IP
|
$11,352.75
|
|
|
Service Code
|
APR-DRG 8903
|
| Min. Negotiated Rate |
$11,352.75 |
| Max. Negotiated Rate |
$11,352.75 |
| Rate for Payer: IEHP Medi-Cal |
$11,352.75
|
|
|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
IP
|
$15,414.92
|
|
|
Service Code
|
APR-DRG 8934
|
| Min. Negotiated Rate |
$15,414.92 |
| Max. Negotiated Rate |
$15,414.92 |
| Rate for Payer: IEHP Medi-Cal |
$15,414.92
|
|
|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
IP
|
$7,233.89
|
|
|
Service Code
|
APR-DRG 8932
|
| Min. Negotiated Rate |
$7,233.89 |
| Max. Negotiated Rate |
$7,233.89 |
| Rate for Payer: IEHP Medi-Cal |
$7,233.89
|
|
|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
IP
|
$10,098.19
|
|
|
Service Code
|
APR-DRG 8933
|
| Min. Negotiated Rate |
$10,098.19 |
| Max. Negotiated Rate |
$10,098.19 |
| Rate for Payer: IEHP Medi-Cal |
$10,098.19
|
|
|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
IP
|
$6,678.74
|
|
|
Service Code
|
APR-DRG 8931
|
| Min. Negotiated Rate |
$6,678.74 |
| Max. Negotiated Rate |
$6,678.74 |
| Rate for Payer: IEHP Medi-Cal |
$6,678.74
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
IP
|
$13,778.32
|
|
|
Service Code
|
APR-DRG 8944
|
| Min. Negotiated Rate |
$13,778.32 |
| Max. Negotiated Rate |
$13,778.32 |
| Rate for Payer: IEHP Medi-Cal |
$13,778.32
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
IP
|
$6,162.38
|
|
|
Service Code
|
APR-DRG 8942
|
| Min. Negotiated Rate |
$6,162.38 |
| Max. Negotiated Rate |
$6,162.38 |
| Rate for Payer: IEHP Medi-Cal |
$6,162.38
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
IP
|
$4,923.74
|
|
|
Service Code
|
APR-DRG 8941
|
| Min. Negotiated Rate |
$4,923.74 |
| Max. Negotiated Rate |
$4,923.74 |
| Rate for Payer: IEHP Medi-Cal |
$4,923.74
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
IP
|
$8,915.26
|
|
|
Service Code
|
APR-DRG 8943
|
| Min. Negotiated Rate |
$8,915.26 |
| Max. Negotiated Rate |
$8,915.26 |
| Rate for Payer: IEHP Medi-Cal |
$8,915.26
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
IP
|
$643.26
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
NDG208396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.43 |
| Max. Negotiated Rate |
$482.44 |
| Rate for Payer: Adventist Health Commercial |
$128.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$441.92
|
| Rate for Payer: Cash Price |
$289.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.49
|
| Rate for Payer: Heritage Provider Network Senior |
$435.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.82
|
| Rate for Payer: Multiplan Commercial |
$482.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$234.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$214.91
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
OP
|
$643.26
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
NDG208396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.43 |
| Max. Negotiated Rate |
$713.05 |
| Rate for Payer: Adventist Health Commercial |
$128.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$713.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$441.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$546.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$353.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$482.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.19
|
| Rate for Payer: Blue Shield of California Commercial |
$274.02
|
| Rate for Payer: Blue Shield of California EPN |
$274.02
|
| Rate for Payer: Cash Price |
$289.47
|
| Rate for Payer: Cash Price |
$289.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.77
|
| Rate for Payer: Dignity Health Senior |
$546.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.83
|
| Rate for Payer: Heritage Provider Network Senior |
$297.83
|
| Rate for Payer: IEHP Medi-Cal |
$454.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$310.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.82
|
| Rate for Payer: Multiplan Commercial |
$482.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$234.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$214.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.77
|
| Rate for Payer: Vantage Medical Group Senior |
$546.77
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION [206243]
|
Facility
IP
|
$3.58
|
|
|
Service Code
|
CPT J7168
|
| Hospital Charge Code |
ERX206243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.46
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION [206243]
|
Facility
OP
|
$3.58
|
|
|
Service Code
|
CPT J7168
|
| Hospital Charge Code |
ERX206243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.90
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.51
|
| Rate for Payer: Dignity Health Senior |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1.66
|
| Rate for Payer: Humana Medicare |
$2.28
|
| Rate for Payer: IEHP Medi-Cal |
$11.61
|
| Rate for Payer: IEHP Medicare Advantage |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.51
|
| Rate for Payer: TriValley Medical Group Senior |
$2.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Vantage Medical Group Senior |
$2.28
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
IP
|
$3.58
|
|
|
Service Code
|
CPT J7168
|
| Hospital Charge Code |
ERX205938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.46
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
OP
|
$3.58
|
|
|
Service Code
|
CPT J7168
|
| Hospital Charge Code |
ERX205938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.90
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.51
|
| Rate for Payer: Dignity Health Senior |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1.66
|
| Rate for Payer: Humana Medicare |
$2.28
|
| Rate for Payer: IEHP Medi-Cal |
$11.61
|
| Rate for Payer: IEHP Medicare Advantage |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.51
|
| Rate for Payer: TriValley Medical Group Senior |
$2.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Vantage Medical Group Senior |
$2.28
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
OP
|
$66.96
|
|
|
Service Code
|
CPT J3473
|
| Hospital Charge Code |
1721178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Adventist Health Commercial |
$13.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.92
|
| Rate for Payer: Dignity Health Senior |
$56.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.00
|
| Rate for Payer: Heritage Provider Network Senior |
$31.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.92
|
| Rate for Payer: Vantage Medical Group Senior |
$56.92
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
IP
|
$66.96
|
|
|
Service Code
|
CPT J3473
|
| Hospital Charge Code |
1721178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$50.22 |
| Rate for Payer: Adventist Health Commercial |
$13.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.00
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.33
|
| Rate for Payer: Heritage Provider Network Senior |
$45.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.37
|
|
|
HYALURONIDASE (OVINE) 200 UNIT/ML INJECTION SOLUTION [40449]
|
Facility
OP
|
$120.83
|
|
|
Service Code
|
CPT J3471
|
| Hospital Charge Code |
1721153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$102.71 |
| Rate for Payer: Adventist Health Commercial |
$24.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$54.37
|
| Rate for Payer: Cash Price |
$54.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.71
|
| Rate for Payer: Dignity Health Senior |
$102.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.94
|
| Rate for Payer: Heritage Provider Network Senior |
$55.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$58.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.21
|
| Rate for Payer: Multiplan Commercial |
$90.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.71
|
| Rate for Payer: Vantage Medical Group Senior |
$102.71
|
|
|
HYALURONIDASE (OVINE) 200 UNIT/ML INJECTION SOLUTION [40449]
|
Facility
IP
|
$120.83
|
|
|
Service Code
|
CPT J3471
|
| Hospital Charge Code |
1721153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$90.62 |
| Rate for Payer: Adventist Health Commercial |
$24.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.01
|
| Rate for Payer: Cash Price |
$54.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.80
|
| Rate for Payer: Heritage Provider Network Senior |
$81.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.21
|
| Rate for Payer: Multiplan Commercial |
$90.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.37
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
NDC 51079-074-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
OP
|
$0.13
|
|
|
Service Code
|
NDC 0904-6440-61
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Senior |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
