|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$7.29 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$3.13
|
| Rate for Payer: Cigna of CA HMO |
$6.39
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$6.39
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$3.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$1.79
|
| Rate for Payer: EPIC Health Plan Senior |
$3.65
|
| Rate for Payer: Galaxy Health WC |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$7.76
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$4.57
|
| Rate for Payer: Networks By Design Commercial |
$2.23
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$7.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$3.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.76
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7.76
|
| Rate for Payer: Vantage Medical Group Senior |
$3.80
|
|
|
MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED RELEASE [38063]
|
Facility
|
OP
|
$11.72
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$9.96 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$8.20
|
| Rate for Payer: Cigna of CA HMO |
$6.39
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$6.39
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$8.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$3.65
|
| Rate for Payer: Galaxy Health WC |
$9.96
|
| Rate for Payer: Galaxy Health WC |
$7.76
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$7.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$5.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$4.57
|
| Rate for Payer: Networks By Design Commercial |
$5.86
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$7.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$9.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3.26
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.76
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$7.76
|
| Rate for Payer: Vantage Medical Group Senior |
$9.96
|
|
|
MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED RELEASE [38063]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$9.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$7.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.63
|
| Rate for Payer: Blue Shield of California Commercial |
$5.94
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$6.39
|
| Rate for Payer: Cigna of CA HMO |
$8.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$6.39
|
| Rate for Payer: Cigna of CA PPO |
$8.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.65
|
| Rate for Payer: Galaxy Health WC |
$7.76
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$9.96
|
| Rate for Payer: Global Benefits Group Commercial |
$7.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$5.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| Rate for Payer: Networks By Design Commercial |
$5.86
|
| Rate for Payer: Networks By Design Commercial |
$4.57
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$9.96
|
| Rate for Payer: Prime Health Services Commercial |
$7.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$4.28
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$120,261.44
|
|
|
Service Code
|
MSDRG 827
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$120,261.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70,066.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$120,261.44
|
| Rate for Payer: EPIC Health Plan Senior |
$80,174.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72,885.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102,040.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97,666.86
|
| 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
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$162,256.36
|
|
|
Service Code
|
MSDRG 826
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$162,256.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$141,812.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$162,256.36
|
| Rate for Payer: EPIC Health Plan Senior |
$108,170.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$98,337.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137,672.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131,771.83
|
| 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
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$109,483.26
|
|
|
Service Code
|
MSDRG 828
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$109,483.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51,652.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$109,483.26
|
| Rate for Payer: EPIC Health Plan Senior |
$72,988.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,353.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92,894.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88,913.68
|
| 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
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$135,323.28
|
|
|
Service Code
|
MSDRG 829
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$135,323.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$95,798.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$135,323.28
|
| Rate for Payer: EPIC Health Plan Senior |
$90,215.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$82,014.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114,819.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109,898.91
|
| 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
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$105,955.59
|
|
|
Service Code
|
MSDRG 830
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$105,955.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,625.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$105,955.59
|
| Rate for Payer: EPIC Health Plan Senior |
$70,637.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64,215.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89,901.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86,048.78
|
| 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
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 69421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,942.61 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,969.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
NADOFARAGENE FIRADENOVEC-VNCG 3X10EXP11 VP/ML INTRAVESICAL SUSPENSION [238729]
|
Facility
|
IP
|
$18,544.05
|
|
|
Service Code
|
HCPCS J9029
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,708.81 |
| Max. Negotiated Rate |
$15,762.44 |
| Rate for Payer: Adventist Health Commercial |
$3,708.81
|
| Rate for Payer: Blue Shield of California Commercial |
$14,260.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9,401.83
|
| Rate for Payer: Cash Price |
$8,344.82
|
| Rate for Payer: Cigna of CA HMO |
$12,980.83
|
| Rate for Payer: Cigna of CA PPO |
$12,980.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,980.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,417.62
|
| Rate for Payer: EPIC Health Plan Senior |
$7,417.62
|
| Rate for Payer: Galaxy Health WC |
$15,762.44
|
| Rate for Payer: Global Benefits Group Commercial |
$11,126.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,775.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,940.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,450.57
|
| Rate for Payer: Multiplan Commercial |
$14,835.24
|
| Rate for Payer: Networks By Design Commercial |
$9,272.02
|
| Rate for Payer: Prime Health Services Commercial |
$15,762.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,959.58
|
| Rate for Payer: United Healthcare All Other HMO |
$6,774.14
|
| Rate for Payer: United Healthcare HMO Rider |
$6,627.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,073.18
|
|
|
NADOFARAGENE FIRADENOVEC-VNCG 3X10EXP11 VP/ML INTRAVESICAL SUSPENSION [238729]
|
Facility
|
OP
|
$18,544.05
|
|
|
Service Code
|
HCPCS J9029
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,708.81 |
| Max. Negotiated Rate |
$397,718.56 |
| Rate for Payer: Adventist Health Commercial |
$3,708.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$397,718.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80,414.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70,764.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70,764.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153,290.83
|
| Rate for Payer: Blue Shield of California Commercial |
$72,000.00
|
| Rate for Payer: Cash Price |
$8,344.82
|
| Rate for Payer: Cash Price |
$8,344.82
|
| Rate for Payer: Cigna of CA HMO |
$12,980.83
|
| Rate for Payer: Cigna of CA PPO |
$12,980.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80,414.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$70,764.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70,764.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,980.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$106,147.16
|
| Rate for Payer: EPIC Health Plan Senior |
$70,764.77
|
| Rate for Payer: Galaxy Health WC |
$15,762.44
|
| Rate for Payer: Global Benefits Group Commercial |
$11,126.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$105,503.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64,331.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64,331.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,775.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122,122.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90,064.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,450.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81,057.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86,204.36
|
| Rate for Payer: Multiplan Commercial |
$14,835.24
|
| Rate for Payer: Networks By Design Commercial |
$9,272.02
|
| Rate for Payer: Prime Health Services Commercial |
$15,762.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,126.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,126.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,959.58
|
| Rate for Payer: United Healthcare All Other HMO |
$6,774.14
|
| Rate for Payer: United Healthcare HMO Rider |
$6,627.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,073.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$64,331.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$80,414.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70,764.77
|
| Rate for Payer: Vantage Medical Group Senior |
$70,764.77
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 6068788711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
IP
|
$6.19
|
|
|
Service Code
|
NDC 5107981201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4.76
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cigna of CA HMO |
$4.33
|
| Rate for Payer: Cigna of CA PPO |
$4.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.48
|
| Rate for Payer: EPIC Health Plan Senior |
$2.48
|
| Rate for Payer: Galaxy Health WC |
$5.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Networks By Design Commercial |
$4.02
|
| Rate for Payer: Prime Health Services Commercial |
$5.26
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6068788721
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.70
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
OP
|
$6.19
|
|
|
Service Code
|
NDC 5107981201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.97
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cigna of CA HMO |
$4.33
|
| Rate for Payer: Cigna of CA PPO |
$4.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.48
|
| Rate for Payer: EPIC Health Plan Senior |
$2.48
|
| Rate for Payer: Galaxy Health WC |
$5.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Networks By Design Commercial |
$4.02
|
| Rate for Payer: Prime Health Services Commercial |
$5.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.10
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.26
|
| Rate for Payer: Vantage Medical Group Senior |
$5.26
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 6068788721
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6068788711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.70
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
NADOLOL ORAL SUSPENSION COMPOUND 10 MG/ML [4080308]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 9994080308
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
NADOLOL ORAL SUSPENSION COMPOUND 10 MG/ML [4080308]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 9994080308
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION [5334]
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$26.76
|
| Rate for Payer: Adventist Health Commercial |
$33.97
|
| Rate for Payer: Blue Shield of California Commercial |
$67.84
|
| Rate for Payer: Blue Shield of California Commercial |
$60.84
|
| Rate for Payer: Blue Shield of California Commercial |
$92.28
|
| Rate for Payer: Blue Shield of California Commercial |
$86.12
|
| Rate for Payer: Blue Shield of California Commercial |
$130.62
|
| Rate for Payer: Blue Shield of California Commercial |
$102.89
|
| Rate for Payer: Cash Price |
$76.44
|
| Rate for Payer: Cash Price |
$60.21
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$118.90
|
| Rate for Payer: Cigna of CA HMO |
$93.66
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$118.90
|
| Rate for Payer: Cigna of CA PPO |
$93.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$53.52
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$67.94
|
| Rate for Payer: Galaxy Health WC |
$144.38
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$113.73
|
| Rate for Payer: Global Benefits Group Commercial |
$80.28
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$101.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.77
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$107.04
|
| Rate for Payer: Multiplan Commercial |
$135.89
|
| Rate for Payer: Networks By Design Commercial |
$66.90
|
| Rate for Payer: Networks By Design Commercial |
$84.93
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$113.73
|
| Rate for Payer: Prime Health Services Commercial |
$144.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.75
|
| Rate for Payer: United Healthcare All Other HMO |
$62.05
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare All Other HMO |
$48.88
|
| Rate for Payer: United Healthcare HMO Rider |
$47.82
|
| Rate for Payer: United Healthcare HMO Rider |
$60.71
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.82
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION [5334]
|
Facility
|
OP
|
$133.80
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$113.73 |
| Rate for Payer: Adventist Health Commercial |
$26.76
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$33.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$76.44
|
| Rate for Payer: Cash Price |
$60.21
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$60.21
|
| Rate for Payer: Cash Price |
$76.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$118.90
|
| Rate for Payer: Cigna of CA HMO |
$93.66
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$118.90
|
| Rate for Payer: Cigna of CA PPO |
$93.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.94
|
| Rate for Payer: EPIC Health Plan Senior |
$67.94
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$53.52
|
| Rate for Payer: Galaxy Health WC |
$113.73
|
| Rate for Payer: Galaxy Health WC |
$144.38
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$80.28
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$101.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.66
|
| Rate for Payer: Multiplan Commercial |
$107.04
|
| Rate for Payer: Multiplan Commercial |
$135.89
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$84.93
|
| Rate for Payer: Networks By Design Commercial |
$66.90
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.38
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$113.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$62.05
|
| Rate for Payer: United Healthcare All Other HMO |
$48.88
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare HMO Rider |
$60.71
|
| Rate for Payer: United Healthcare HMO Rider |
$47.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.38
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$144.38
|
| Rate for Payer: Vantage Medical Group Senior |
$113.73
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Dignity Health Medi-Cal |
$15.19
|
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Adventist Health Commercial |
$2.51
|
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$9.83
|
| Rate for Payer: Cigna of CA HMO |
$8.78
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA HMO |
$12.51
|
| Rate for Payer: Cigna of CA PPO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$12.51
|
| Rate for Payer: Cigna of CA PPO |
$8.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$5.52
|
| Rate for Payer: EPIC Health Plan Senior |
$7.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$11.93
|
| Rate for Payer: Galaxy Health WC |
$15.19
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Galaxy Health WC |
$10.66
|
| Rate for Payer: Galaxy Health WC |
$11.73
|
| Rate for Payer: Global Benefits Group Commercial |
$7.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Global Benefits Group Commercial |
$10.72
|
| Rate for Payer: Global Benefits Group Commercial |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$8.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.51
|
| Rate for Payer: Multiplan Commercial |
$10.03
|
| Rate for Payer: Multiplan Commercial |
$14.30
|
| Rate for Payer: Multiplan Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Networks By Design Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$8.94
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Prime Health Services Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$15.19
|
| Rate for Payer: Prime Health Services Commercial |
$11.93
|
| Rate for Payer: Prime Health Services Commercial |
$10.66
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$4.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.13
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$4.93
|
| Rate for Payer: United Healthcare HMO Rider |
$5.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.48
|
| Rate for Payer: United Healthcare HMO Rider |
$6.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.19
|
| Rate for Payer: Vantage Medical Group Senior |
$15.19
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$10.66
|
| Rate for Payer: Vantage Medical Group Senior |
$11.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.93
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]
|
Facility
|
IP
|
$14.04
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$11.93 |
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Adventist Health Commercial |
$2.51
|
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California Commercial |
$9.64
|
| Rate for Payer: Blue Shield of California Commercial |
$6.36
|
| Rate for Payer: Blue Shield of California Commercial |
$8.77
|
| Rate for Payer: Blue Shield of California Commercial |
$10.61
|
| Rate for Payer: Blue Shield of California Commercial |
$13.74
|
| Rate for Payer: Blue Shield of California Commercial |
$9.06
|
| Rate for Payer: Blue Shield of California Commercial |
$7.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7.12
|
| Rate for Payer: Blue Shield of California Commercial |
$5.78
|
| Rate for Payer: Blue Shield of California Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cigna of CA HMO |
$9.83
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA HMO |
$8.78
|
| Rate for Payer: Cigna of CA HMO |
$12.51
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Cigna of CA PPO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$8.78
|
| Rate for Payer: Cigna of CA PPO |
$12.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$5.62
|
| Rate for Payer: EPIC Health Plan Senior |
$7.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.52
|
| Rate for Payer: EPIC Health Plan Senior |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$10.66
|
| Rate for Payer: Galaxy Health WC |
$11.73
|
| Rate for Payer: Galaxy Health WC |
$15.19
|
| Rate for Payer: Galaxy Health WC |
$11.93
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$8.28
|
| Rate for Payer: Global Benefits Group Commercial |
$7.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Global Benefits Group Commercial |
$10.72
|
| Rate for Payer: Global Benefits Group Commercial |
$8.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$10.03
|
| Rate for Payer: Multiplan Commercial |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$14.30
|
| Rate for Payer: Networks By Design Commercial |
$8.94
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Networks By Design Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.19
|
| Rate for Payer: Prime Health Services Commercial |
$11.93
|
| Rate for Payer: Prime Health Services Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$10.66
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.13
|
| Rate for Payer: United Healthcare All Other HMO |
$4.58
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.93
|
| Rate for Payer: United Healthcare HMO Rider |
$6.39
|
| Rate for Payer: United Healthcare HMO Rider |
$5.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.73
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]
|
Facility
|
IP
|
$25.08
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$21.32 |
| Rate for Payer: Adventist Health Commercial |
$5.02
|
| Rate for Payer: Adventist Health Commercial |
$6.93
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Blue Shield of California Commercial |
$20.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5.63
|
| Rate for Payer: Blue Shield of California Commercial |
$17.58
|
| Rate for Payer: Blue Shield of California Commercial |
$19.29
|
| Rate for Payer: Blue Shield of California Commercial |
$12.72
|
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$26.66
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cigna of CA HMO |
$18.23
|
| Rate for Payer: Cigna of CA HMO |
$17.56
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$24.27
|
| Rate for Payer: Cigna of CA PPO |
$24.27
|
| Rate for Payer: Cigna of CA PPO |
$18.23
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$17.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.87
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: EPIC Health Plan Senior |
$10.03
|
| Rate for Payer: EPIC Health Plan Senior |
$10.42
|
| Rate for Payer: EPIC Health Plan Senior |
$13.87
|
| Rate for Payer: Galaxy Health WC |
$29.47
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Galaxy Health WC |
$21.32
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$20.83
|
| Rate for Payer: Multiplan Commercial |
$20.06
|
| Rate for Payer: Multiplan Commercial |
$27.74
|
| Rate for Payer: Networks By Design Commercial |
$12.54
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Networks By Design Commercial |
$17.34
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$29.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$9.16
|
| Rate for Payer: United Healthcare All Other HMO |
$12.66
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$8.96
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$9.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.53
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]
|
Facility
|
OP
|
$26.04
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Adventist Health Commercial |
$5.02
|
| Rate for Payer: Adventist Health Commercial |
$6.93
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$17.56
|
| Rate for Payer: Cigna of CA HMO |
$18.23
|
| Rate for Payer: Cigna of CA HMO |
$24.27
|
| Rate for Payer: Cigna of CA PPO |
$18.23
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$17.56
|
| Rate for Payer: Cigna of CA PPO |
$24.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.42
|
| Rate for Payer: EPIC Health Plan Senior |
$10.42
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: EPIC Health Plan Senior |
$10.03
|
| Rate for Payer: EPIC Health Plan Senior |
$13.87
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Galaxy Health WC |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$29.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.56
|
| Rate for Payer: Multiplan Commercial |
$20.06
|
| Rate for Payer: Multiplan Commercial |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$20.83
|
| Rate for Payer: Multiplan Commercial |
$27.74
|
| Rate for Payer: Networks By Design Commercial |
$17.34
|
| Rate for Payer: Networks By Design Commercial |
$12.54
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Prime Health Services Commercial |
$21.32
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$29.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$12.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$9.16
|
| Rate for Payer: United Healthcare HMO Rider |
$8.96
|
| Rate for Payer: United Healthcare HMO Rider |
$9.31
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Vantage Medical Group Senior |
$29.47
|
| Rate for Payer: Vantage Medical Group Senior |
$21.32
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
