|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$13,058.00
|
|
|
Service Code
|
APR-DRG 7733
|
| Min. Negotiated Rate |
$10,429.22 |
| Max. Negotiated Rate |
$13,058.00 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,058.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,683.47
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$7,005.36
|
|
|
Service Code
|
APR-DRG 7732
|
| Min. Negotiated Rate |
$5,595.07 |
| Max. Negotiated Rate |
$7,005.36 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,595.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,005.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,267.95
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$4,975.06
|
|
|
Service Code
|
APR-DRG 7731
|
| Min. Negotiated Rate |
$3,973.50 |
| Max. Negotiated Rate |
$4,975.06 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,973.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,975.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,451.36
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
OP
|
$6.28
|
|
|
Service Code
|
NDC 9999999405
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.03
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Vantage Medical Group Senior |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
IP
|
$6.28
|
|
|
Service Code
|
NDC 4279921701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4.83
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
OP
|
$6.28
|
|
|
Service Code
|
NDC 4279921701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.03
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Vantage Medical Group Senior |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
IP
|
$6.28
|
|
|
Service Code
|
NDC 9999999405
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4.83
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
|
|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$120,969.47
|
|
|
Service Code
|
MSDRG 113
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$120,969.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71,275.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$120,969.47
|
| Rate for Payer: EPIC Health Plan Senior |
$80,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73,314.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102,640.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98,241.87
|
| 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
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$103,258.37
|
|
|
Service Code
|
MSDRG 114
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$103,258.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,017.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$103,258.37
|
| Rate for Payer: EPIC Health Plan Senior |
$68,838.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,580.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87,613.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,858.31
|
| 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
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$25,125.01
|
|
|
Service Code
|
APR-DRG 0732
|
| Min. Negotiated Rate |
$20,066.95 |
| Max. Negotiated Rate |
$25,125.01 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,066.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,125.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,480.27
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$18,824.72
|
|
|
Service Code
|
APR-DRG 0731
|
| Min. Negotiated Rate |
$15,035.01 |
| Max. Negotiated Rate |
$18,824.72 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,035.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,824.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,843.17
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$38,084.51
|
|
|
Service Code
|
APR-DRG 0733
|
| Min. Negotiated Rate |
$30,417.50 |
| Max. Negotiated Rate |
$38,084.51 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30,417.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38,084.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,075.62
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$92,565.62
|
|
|
Service Code
|
APR-DRG 0734
|
| Min. Negotiated Rate |
$73,930.70 |
| Max. Negotiated Rate |
$92,565.62 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73,930.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92,565.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82,821.88
|
|
|
ORCHIOPEXY, INGUINAL OR SCROTAL APPROACH
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 54640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$750.56 |
| 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 |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,598.23
|
| Rate for Payer: EPIC Health Plan Senior |
$5,065.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,552.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$750.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,446.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,802.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,170.69
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,604.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$107,799.27
|
|
|
Service Code
|
MSDRG 884
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$107,799.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,775.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$107,799.27
|
| Rate for Payer: EPIC Health Plan Senior |
$71,866.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,332.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91,466.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,546.07
|
| 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
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$7,019.45
|
|
|
Service Code
|
APR-DRG 7571
|
| Min. Negotiated Rate |
$5,606.33 |
| Max. Negotiated Rate |
$7,019.45 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,606.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,019.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,280.56
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$15,392.43
|
|
|
Service Code
|
APR-DRG 7573
|
| Min. Negotiated Rate |
$12,293.69 |
| Max. Negotiated Rate |
$15,392.43 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,293.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,392.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,772.18
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$36,968.45
|
|
|
Service Code
|
APR-DRG 7574
|
| Min. Negotiated Rate |
$29,526.12 |
| Max. Negotiated Rate |
$36,968.45 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29,526.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36,968.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,077.04
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$10,657.08
|
|
|
Service Code
|
APR-DRG 7572
|
| Min. Negotiated Rate |
$8,511.64 |
| Max. Negotiated Rate |
$10,657.08 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,511.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,657.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,535.28
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
|
IP
|
$6,993.44
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,398.69 |
| Max. Negotiated Rate |
$5,944.42 |
| Rate for Payer: Adventist Health Commercial |
$1,398.69
|
| Rate for Payer: Blue Shield of California Commercial |
$3,545.67
|
| Rate for Payer: Blue Shield of California Commercial |
$5,377.96
|
| Rate for Payer: Cash Price |
$3,147.05
|
| Rate for Payer: Cigna of CA HMO |
$4,895.41
|
| Rate for Payer: Cigna of CA PPO |
$4,895.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,895.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,797.38
|
| Rate for Payer: EPIC Health Plan Senior |
$2,797.38
|
| Rate for Payer: Galaxy Health WC |
$5,944.42
|
| Rate for Payer: Global Benefits Group Commercial |
$4,196.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,440.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,126.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,678.43
|
| Rate for Payer: Multiplan Commercial |
$5,594.75
|
| Rate for Payer: Networks By Design Commercial |
$3,496.72
|
| Rate for Payer: Prime Health Services Commercial |
$5,944.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,624.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2,554.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,290.35
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
|
OP
|
$6,993.44
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.41 |
| Max. Negotiated Rate |
$5,944.42 |
| Rate for Payer: Adventist Health Commercial |
$1,398.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$268.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.99
|
| Rate for Payer: Blue Shield of California Commercial |
$53.37
|
| Rate for Payer: Cash Price |
$3,147.05
|
| Rate for Payer: Cash Price |
$3,147.05
|
| Rate for Payer: Cigna of CA HMO |
$4,895.41
|
| Rate for Payer: Cigna of CA PPO |
$4,895.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,895.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.23
|
| Rate for Payer: EPIC Health Plan Senior |
$52.15
|
| Rate for Payer: Galaxy Health WC |
$5,944.42
|
| Rate for Payer: Global Benefits Group Commercial |
$4,196.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,440.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,678.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.53
|
| Rate for Payer: Multiplan Commercial |
$5,594.75
|
| Rate for Payer: Networks By Design Commercial |
$3,496.72
|
| Rate for Payer: Prime Health Services Commercial |
$5,944.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,196.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,196.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,624.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2,554.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,290.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.15
|
| Rate for Payer: Vantage Medical Group Senior |
$52.15
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION [207378]
|
Facility
|
IP
|
$1,434.76
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$286.95 |
| Max. Negotiated Rate |
$1,219.55 |
| Rate for Payer: Adventist Health Commercial |
$286.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,103.33
|
| Rate for Payer: Blue Shield of California Commercial |
$727.42
|
| Rate for Payer: Cash Price |
$645.64
|
| Rate for Payer: Cigna of CA HMO |
$1,004.33
|
| Rate for Payer: Cigna of CA PPO |
$1,004.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,004.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.90
|
| Rate for Payer: EPIC Health Plan Senior |
$573.90
|
| Rate for Payer: Galaxy Health WC |
$1,219.55
|
| Rate for Payer: Global Benefits Group Commercial |
$860.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$911.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$846.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.34
|
| Rate for Payer: Multiplan Commercial |
$1,147.81
|
| Rate for Payer: Networks By Design Commercial |
$717.38
|
| Rate for Payer: Prime Health Services Commercial |
$1,219.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$538.47
|
| Rate for Payer: United Healthcare All Other HMO |
$524.12
|
| Rate for Payer: United Healthcare HMO Rider |
$512.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$469.88
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION [207378]
|
Facility
|
OP
|
$1,434.76
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.73 |
| Max. Negotiated Rate |
$1,219.55 |
| Rate for Payer: Adventist Health Commercial |
$286.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.77
|
| Rate for Payer: Blue Shield of California Commercial |
$34.82
|
| Rate for Payer: Cash Price |
$645.64
|
| Rate for Payer: Cash Price |
$645.64
|
| Rate for Payer: Cigna of CA HMO |
$1,004.33
|
| Rate for Payer: Cigna of CA PPO |
$1,004.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,004.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.05
|
| Rate for Payer: EPIC Health Plan Senior |
$32.70
|
| Rate for Payer: Galaxy Health WC |
$1,219.55
|
| Rate for Payer: Global Benefits Group Commercial |
$860.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$911.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.84
|
| Rate for Payer: Multiplan Commercial |
$1,147.81
|
| Rate for Payer: Networks By Design Commercial |
$717.38
|
| Rate for Payer: Prime Health Services Commercial |
$1,219.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$860.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$860.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$538.47
|
| Rate for Payer: United Healthcare All Other HMO |
$524.12
|
| Rate for Payer: United Healthcare HMO Rider |
$512.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$469.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.70
|
| Rate for Payer: Vantage Medical Group Senior |
$32.70
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$77.53 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.89
|
| Rate for Payer: Blue Shield of California Commercial |
$17.64
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
|
