|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$10,207.71
|
|
|
Service Code
|
APR-DRG 2471
|
| Min. Negotiated Rate |
$8,152.74 |
| Max. Negotiated Rate |
$10,207.71 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,152.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,207.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,133.22
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$13,247.73
|
|
|
Service Code
|
APR-DRG 2472
|
| Min. Negotiated Rate |
$10,580.75 |
| Max. Negotiated Rate |
$13,247.73 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,580.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,247.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,853.23
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$45,311.71
|
|
|
Service Code
|
APR-DRG 2474
|
| Min. Negotiated Rate |
$36,189.75 |
| Max. Negotiated Rate |
$45,311.71 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36,189.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45,311.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,542.06
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$19,996.68
|
|
|
Service Code
|
APR-DRG 2473
|
| Min. Negotiated Rate |
$15,971.03 |
| Max. Negotiated Rate |
$19,996.68 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,971.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,996.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,891.77
|
|
|
INTRACARDIAC ELECTROPHYSIOLOGIC 3-DIMENSIONAL MAPPING (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 93613
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$525.07 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$593.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
|
IP
|
$53,298.99
|
|
|
Service Code
|
APR-DRG 0444
|
| Min. Negotiated Rate |
$42,569.06 |
| Max. Negotiated Rate |
$53,298.99 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42,569.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53,298.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,688.57
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
|
IP
|
$15,197.36
|
|
|
Service Code
|
APR-DRG 0441
|
| Min. Negotiated Rate |
$12,137.89 |
| Max. Negotiated Rate |
$15,197.36 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,137.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,197.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,597.64
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
|
IP
|
$20,575.86
|
|
|
Service Code
|
APR-DRG 0442
|
| Min. Negotiated Rate |
$16,433.61 |
| Max. Negotiated Rate |
$20,575.86 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16,433.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,575.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,409.98
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
|
IP
|
$27,254.11
|
|
|
Service Code
|
APR-DRG 0443
|
| Min. Negotiated Rate |
$21,767.43 |
| Max. Negotiated Rate |
$27,254.11 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21,767.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,254.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,385.26
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS
|
Facility
|
IP
|
$97,177.21
|
|
|
Service Code
|
MSDRG 065
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$97,177.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,628.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,177.21
|
| Rate for Payer: EPIC Health Plan Senior |
$64,784.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,895.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,453.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,919.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC
|
Facility
|
IP
|
$114,934.46
|
|
|
Service Code
|
MSDRG 064
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$114,934.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60,965.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$114,934.46
|
| Rate for Payer: EPIC Health Plan Senior |
$76,622.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$69,657.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97,520.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93,340.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$91,394.19
|
|
|
Service Code
|
MSDRG 066
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$91,394.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,748.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$91,394.19
|
| Rate for Payer: EPIC Health Plan Senior |
$60,929.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,390.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77,546.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,223.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC
|
Facility
|
IP
|
$173,187.17
|
|
|
Service Code
|
MSDRG 021
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$173,187.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$160,486.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$173,187.17
|
| Rate for Payer: EPIC Health Plan Senior |
$115,458.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$104,961.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146,946.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140,648.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$238,550.54
|
|
|
Service Code
|
MSDRG 020
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$238,550.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$238,550.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$218,880.09
|
| Rate for Payer: EPIC Health Plan Senior |
$145,920.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$132,654.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185,716.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177,757.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$135,632.01
|
|
|
Service Code
|
MSDRG 022
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$135,632.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$93,224.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$135,632.01
|
| Rate for Payer: EPIC Health Plan Senior |
$90,421.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$82,201.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115,081.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110,149.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
INTRAOCULAR PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$111,334.03
|
|
|
Service Code
|
MSDRG 116
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$111,334.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,814.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$111,334.03
|
| Rate for Payer: EPIC Health Plan Senior |
$74,222.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67,475.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94,465.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90,416.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
INTRAOCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$98,500.97
|
|
|
Service Code
|
MSDRG 117
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$98,500.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,889.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$98,500.97
|
| Rate for Payer: EPIC Health Plan Senior |
$65,667.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,697.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83,576.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,994.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
INTRAOPERATIVE NEAR-INFRARED FLUORESCENCE IMAGING OF MAJOR EXTRA-HEPATIC BILE DUCT(S) (E.G., CYSTIC DUCT, COMMON BILE DUCT AND COMMON HEPATIC DUCT) WITH INTRAVENOUS ADMINISTRATION OF INDOCYANINE GREEN (ICG) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT C9776
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
|
|
INTRAOP GENTAMICIN 80 MG/2 ML INJECTION [4083426]
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$2.22
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$1.10
|
| Rate for Payer: Cigna of CA PPO |
$2.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.91
|
| Rate for Payer: EPIC Health Plan Senior |
$1.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
|
|
INTRAOP GENTAMICIN 80 MG/2 ML INJECTION [4083426]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$15.51 |
| Rate for Payer: Vantage Medical Group Senior |
$1.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$2.22
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$2.22
|
| Rate for Payer: Cigna of CA PPO |
$1.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.91
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
INTRAOP KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [4081385]
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$21.53 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$4.19
|
| Rate for Payer: Cigna of CA HMO |
$4.79
|
| Rate for Payer: Cigna of CA HMO |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$4.79
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Cigna of CA PPO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$4.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Multiplan Commercial |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Networks By Design Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
| Rate for Payer: Prime Health Services Commercial |
$6.66
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
INTRAOP KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [4081385]
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3.47
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$4.79
|
| Rate for Payer: Cigna of CA HMO |
$4.19
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$4.79
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Cigna of CA PPO |
$5.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2.74
|
| Rate for Payer: EPIC Health Plan Senior |
$3.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Galaxy Health WC |
$6.66
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$4.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$6.66
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
|
|
INTRAOP ONLY CEFAZOLIN POWDER 1 G [4081027]
|
Facility
|
OP
|
$1.72
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
INTRAOP ONLY CEFAZOLIN POWDER 1 G [4081027]
|
Facility
|
IP
|
$1.72
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
|
|
INTRAOP ONLY DEXTROSE 5 % IN LACTATED RINGERS SOAK SOLUTION [408978801]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
