|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
|
IP
|
$35,343.59
|
|
|
Service Code
|
APR-DRG 3643
|
| Min. Negotiated Rate |
$28,228.37 |
| Max. Negotiated Rate |
$35,343.59 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28,228.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35,343.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,623.21
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
|
IP
|
$77,711.98
|
|
|
Service Code
|
APR-DRG 3644
|
| Min. Negotiated Rate |
$62,067.33 |
| Max. Negotiated Rate |
$77,711.98 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62,067.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77,711.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69,531.77
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$25,704.19
|
|
|
Service Code
|
APR-DRG 2231
|
| Min. Negotiated Rate |
$20,529.53 |
| Max. Negotiated Rate |
$25,704.19 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,529.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,704.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,998.48
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$45,426.23
|
|
|
Service Code
|
APR-DRG 2233
|
| Min. Negotiated Rate |
$36,281.21 |
| Max. Negotiated Rate |
$45,426.23 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36,281.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45,426.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,644.52
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$31,795.09
|
|
|
Service Code
|
APR-DRG 2232
|
| Min. Negotiated Rate |
$25,394.24 |
| Max. Negotiated Rate |
$31,795.09 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,394.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,795.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,448.24
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$102,477.45
|
|
|
Service Code
|
APR-DRG 2234
|
| Min. Negotiated Rate |
$81,847.12 |
| Max. Negotiated Rate |
$102,477.45 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81,847.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102,477.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91,690.35
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$16,420.98
|
|
|
Service Code
|
APR-DRG 2221
|
| Min. Negotiated Rate |
$13,115.18 |
| Max. Negotiated Rate |
$16,420.98 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,115.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,420.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,692.45
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$106,115.08
|
|
|
Service Code
|
APR-DRG 2224
|
| Min. Negotiated Rate |
$84,752.44 |
| Max. Negotiated Rate |
$106,115.08 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84,752.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106,115.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94,945.07
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$29,133.04
|
|
|
Service Code
|
APR-DRG 2222
|
| Min. Negotiated Rate |
$23,268.10 |
| Max. Negotiated Rate |
$29,133.04 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,268.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,133.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,066.41
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$45,301.15
|
|
|
Service Code
|
APR-DRG 2223
|
| Min. Negotiated Rate |
$36,181.31 |
| Max. Negotiated Rate |
$45,301.15 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36,181.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45,301.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,532.61
|
|
|
OTHER VASCULAR PROCEDURES WITH CC
|
Facility
|
IP
|
$125,308.08
|
|
|
Service Code
|
MSDRG 253
|
| Min. Negotiated Rate |
$25,651.00 |
| Max. Negotiated Rate |
$125,308.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78,688.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$125,308.08
|
| Rate for Payer: EPIC Health Plan Senior |
$83,538.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75,944.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106,322.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101,765.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,936.00
|
| Rate for Payer: United Healthcare All Other HMO |
$43,936.00
|
| Rate for Payer: United Healthcare HMO Rider |
$29,046.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26,610.00
|
|
|
OTHER VASCULAR PROCEDURES WITH MCC
|
Facility
|
IP
|
$141,148.89
|
|
|
Service Code
|
MSDRG 252
|
| Min. Negotiated Rate |
$25,651.00 |
| Max. Negotiated Rate |
$141,148.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105,751.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$141,148.89
|
| Rate for Payer: EPIC Health Plan Senior |
$94,099.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85,544.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119,762.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114,630.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,180.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42,180.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,795.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29,128.00
|
|
|
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$110,865.58
|
|
|
Service Code
|
MSDRG 254
|
| Min. Negotiated Rate |
$19,823.00 |
| Max. Negotiated Rate |
$110,865.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,014.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$110,865.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73,910.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67,191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94,067.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90,036.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$56,697.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56,697.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21,636.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,823.00
|
|
|
OTITIS MEDIA AND URI WITH MCC
|
Facility
|
IP
|
$100,227.55
|
|
|
Service Code
|
MSDRG 152
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$100,227.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,839.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$100,227.55
|
| Rate for Payer: EPIC Health Plan Senior |
$66,818.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,743.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85,041.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81,396.92
|
| 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
|
|
|
OTITIS MEDIA AND URI WITHOUT MCC
|
Facility
|
IP
|
$92,348.85
|
|
|
Service Code
|
MSDRG 153
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$92,348.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,379.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$92,348.85
|
| Rate for Payer: EPIC Health Plan Senior |
$61,565.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,969.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78,356.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,998.46
|
| 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
|
|
|
OTOLARYNGOLOGIC EXAMINATION UNDER GENERAL ANESTHESIA
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 92502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.76 |
| 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 |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$971.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
|
IP
|
$140.16
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$119.14 |
| Rate for Payer: Adventist Health Commercial |
$28.03
|
| Rate for Payer: Adventist Health Commercial |
$26.64
|
| Rate for Payer: Blue Shield of California Commercial |
$67.53
|
| Rate for Payer: Blue Shield of California Commercial |
$107.78
|
| Rate for Payer: Blue Shield of California Commercial |
$71.06
|
| Rate for Payer: Blue Shield of California Commercial |
$102.43
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cigna of CA HMO |
$98.11
|
| Rate for Payer: Cigna of CA HMO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$98.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.06
|
| Rate for Payer: EPIC Health Plan Senior |
$53.28
|
| Rate for Payer: EPIC Health Plan Senior |
$56.06
|
| Rate for Payer: Galaxy Health WC |
$113.22
|
| Rate for Payer: Galaxy Health WC |
$119.14
|
| Rate for Payer: Global Benefits Group Commercial |
$84.10
|
| Rate for Payer: Global Benefits Group Commercial |
$79.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.64
|
| Rate for Payer: Multiplan Commercial |
$106.56
|
| Rate for Payer: Multiplan Commercial |
$112.13
|
| Rate for Payer: Networks By Design Commercial |
$70.08
|
| Rate for Payer: Networks By Design Commercial |
$66.60
|
| Rate for Payer: Prime Health Services Commercial |
$119.14
|
| Rate for Payer: Prime Health Services Commercial |
$113.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.60
|
| Rate for Payer: United Healthcare All Other HMO |
$51.20
|
| Rate for Payer: United Healthcare All Other HMO |
$48.66
|
| Rate for Payer: United Healthcare HMO Rider |
$47.61
|
| Rate for Payer: United Healthcare HMO Rider |
$50.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.90
|
|
|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
|
OP
|
$133.20
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Adventist Health Commercial |
$26.64
|
| Rate for Payer: Adventist Health Commercial |
$28.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.90
|
| 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 |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cigna of CA HMO |
$98.11
|
| Rate for Payer: Cigna of CA HMO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$98.11
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.06
|
| Rate for Payer: EPIC Health Plan Senior |
$56.06
|
| Rate for Payer: EPIC Health Plan Senior |
$53.28
|
| Rate for Payer: Galaxy Health WC |
$119.14
|
| Rate for Payer: Galaxy Health WC |
$113.22
|
| Rate for Payer: Global Benefits Group Commercial |
$84.10
|
| Rate for Payer: Global Benefits Group Commercial |
$79.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.11
|
| Rate for Payer: Multiplan Commercial |
$112.13
|
| Rate for Payer: Multiplan Commercial |
$106.56
|
| Rate for Payer: Networks By Design Commercial |
$70.08
|
| Rate for Payer: Networks By Design Commercial |
$66.60
|
| Rate for Payer: Prime Health Services Commercial |
$113.22
|
| Rate for Payer: Prime Health Services Commercial |
$119.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.60
|
| Rate for Payer: United Healthcare All Other HMO |
$48.66
|
| Rate for Payer: United Healthcare All Other HMO |
$51.20
|
| Rate for Payer: United Healthcare HMO Rider |
$50.09
|
| Rate for Payer: United Healthcare HMO Rider |
$47.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.14
|
| Rate for Payer: Vantage Medical Group Senior |
$113.22
|
| Rate for Payer: Vantage Medical Group Senior |
$119.14
|
|
|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
|
IP
|
$9.95
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$6.87
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$10.43
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$6.96
|
| Rate for Payer: Cigna of CA HMO |
$9.49
|
| Rate for Payer: Cigna of CA PPO |
$9.49
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Senior |
$5.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$8.46
|
| Rate for Payer: Global Benefits Group Commercial |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$7.96
|
| Rate for Payer: Networks By Design Commercial |
$4.97
|
| Rate for Payer: Networks By Design Commercial |
$6.78
|
| Rate for Payer: Prime Health Services Commercial |
$8.46
|
| Rate for Payer: Prime Health Services Commercial |
$11.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare All Other HMO |
$4.95
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
|
|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
|
OP
|
$13.56
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$11.53 |
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.17
|
| 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 |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$6.96
|
| Rate for Payer: Cigna of CA HMO |
$9.49
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Cigna of CA PPO |
$9.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Senior |
$3.98
|
| Rate for Payer: EPIC Health Plan Senior |
$5.42
|
| Rate for Payer: Galaxy Health WC |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$11.53
|
| Rate for Payer: Global Benefits Group Commercial |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$8.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.96
|
| Rate for Payer: Multiplan Commercial |
$7.96
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: Networks By Design Commercial |
$4.97
|
| Rate for Payer: Networks By Design Commercial |
$6.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$8.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
|
|
OXACILLIN 2 GRAM SOLUTION FOR INJECTION [5926]
|
Facility
|
OP
|
$27.12
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Adventist Health Commercial |
$5.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.02
|
| 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 |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$19.62
|
| Rate for Payer: Cigna of CA HMO |
$18.98
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$19.62
|
| Rate for Payer: Cigna of CA PPO |
$18.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Senior |
$11.21
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$23.05
|
| Rate for Payer: Galaxy Health WC |
$23.83
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Global Benefits Group Commercial |
$16.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.98
|
| Rate for Payer: Multiplan Commercial |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$22.42
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$14.02
|
| Rate for Payer: Networks By Design Commercial |
$13.56
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Prime Health Services Commercial |
$23.83
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$23.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10.24
|
| Rate for Payer: United Healthcare All Other HMO |
$9.91
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.86
|
| Rate for Payer: United Healthcare HMO Rider |
$10.02
|
| Rate for Payer: United Healthcare HMO Rider |
$9.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.83
|
| Rate for Payer: Vantage Medical Group Senior |
$9.18
|
| Rate for Payer: Vantage Medical Group Senior |
$23.83
|
| Rate for Payer: Vantage Medical Group Senior |
$23.05
|
|
|
OXACILLIN 2 GRAM SOLUTION FOR INJECTION [5926]
|
Facility
|
IP
|
$10.80
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Adventist Health Commercial |
$5.61
|
| Rate for Payer: Blue Shield of California Commercial |
$20.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8.31
|
| Rate for Payer: Blue Shield of California Commercial |
$21.56
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California Commercial |
$13.75
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$19.62
|
| Rate for Payer: Cigna of CA HMO |
$18.98
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$19.62
|
| Rate for Payer: Cigna of CA PPO |
$18.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$10.85
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$11.21
|
| Rate for Payer: Galaxy Health WC |
$23.83
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Galaxy Health WC |
$23.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Global Benefits Group Commercial |
$16.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$22.42
|
| Rate for Payer: Networks By Design Commercial |
$13.56
|
| Rate for Payer: Networks By Design Commercial |
$14.02
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$23.05
|
| Rate for Payer: Prime Health Services Commercial |
$23.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO |
$9.91
|
| Rate for Payer: United Healthcare HMO Rider |
$9.69
|
| Rate for Payer: United Healthcare HMO Rider |
$10.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.88
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1.73
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
|
|
OXALIPLATIN 100 MG INTRAVENOUS SOLUTION [23929]
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$540.60 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Adventist Health Commercial |
$25.30
|
| Rate for Payer: Blue Shield of California Commercial |
$97.26
|
| Rate for Payer: Blue Shield of California Commercial |
$322.45
|
| Rate for Payer: Blue Shield of California Commercial |
$489.08
|
| Rate for Payer: Blue Shield of California Commercial |
$64.13
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO |
$445.20
|
| Rate for Payer: Cigna of CA HMO |
$88.54
|
| Rate for Payer: Cigna of CA PPO |
$88.54
|
| Rate for Payer: Cigna of CA PPO |
$445.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$445.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.59
|
| Rate for Payer: EPIC Health Plan Senior |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$107.51
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Global Benefits Group Commercial |
$75.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$403.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$375.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Multiplan Commercial |
$101.18
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$318.00
|
| Rate for Payer: Networks By Design Commercial |
$63.24
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
| Rate for Payer: Prime Health Services Commercial |
$107.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.69
|
| Rate for Payer: United Healthcare All Other HMO |
$232.33
|
| Rate for Payer: United Healthcare All Other HMO |
$46.20
|
| Rate for Payer: United Healthcare HMO Rider |
$45.20
|
| Rate for Payer: United Healthcare HMO Rider |
$227.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.29
|
|
