|
SIMPLE SYRUP [7242]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 3877917798
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
SIMPLE SYRUP [7242]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 3172293747
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
SIMPLE SYRUP [7242]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0395266116
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
SIMPLE SYRUP [7242]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 3172293747
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
SIMPLE SYRUP [7242]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 3877917791
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
|
SIMPLE SYRUP [7242]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 3877917791
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
|
IP
|
$178,702.26
|
|
|
Service Code
|
MSDRG 008
|
| Min. Negotiated Rate |
$85,000.00 |
| Max. Negotiated Rate |
$178,702.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$169,909.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$178,702.26
|
| Rate for Payer: EPIC Health Plan Senior |
$119,134.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$108,304.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$151,626.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$145,127.90
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS
|
Facility
|
IP
|
$205,851.86
|
|
|
Service Code
|
MSDRG 019
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$205,851.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$200,910.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205,851.86
|
| Rate for Payer: EPIC Health Plan Senior |
$137,234.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$124,758.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174,662.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167,176.66
|
| 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
|
|
|
SIMVASTATIN 20 MG TABLET [11365]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 6808451201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
SIMVASTATIN 20 MG TABLET [11365]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 6808451201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION [11368]
|
Facility
|
IP
|
$156.56
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$133.08 |
| Rate for Payer: Adventist Health Commercial |
$31.31
|
| Rate for Payer: Blue Shield of California Commercial |
$120.39
|
| Rate for Payer: Blue Shield of California Commercial |
$79.38
|
| Rate for Payer: Cash Price |
$70.45
|
| Rate for Payer: Cigna of CA HMO |
$109.59
|
| Rate for Payer: Cigna of CA PPO |
$109.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.62
|
| Rate for Payer: EPIC Health Plan Senior |
$62.62
|
| Rate for Payer: Galaxy Health WC |
$133.08
|
| Rate for Payer: Global Benefits Group Commercial |
$93.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.57
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: Networks By Design Commercial |
$78.28
|
| Rate for Payer: Prime Health Services Commercial |
$133.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.76
|
| Rate for Payer: United Healthcare All Other HMO |
$57.19
|
| Rate for Payer: United Healthcare HMO Rider |
$55.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.27
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION [11368]
|
Facility
|
OP
|
$156.56
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$901.01 |
| Rate for Payer: Adventist Health Commercial |
$31.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.44
|
| Rate for Payer: Blue Shield of California Commercial |
$148.96
|
| Rate for Payer: Cash Price |
$70.45
|
| Rate for Payer: Cash Price |
$70.45
|
| Rate for Payer: Cigna of CA HMO |
$109.59
|
| Rate for Payer: Cigna of CA PPO |
$109.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.62
|
| Rate for Payer: EPIC Health Plan Senior |
$62.62
|
| Rate for Payer: Galaxy Health WC |
$133.08
|
| Rate for Payer: Global Benefits Group Commercial |
$93.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.59
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: Networks By Design Commercial |
$78.28
|
| Rate for Payer: Prime Health Services Commercial |
$133.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.76
|
| Rate for Payer: United Healthcare All Other HMO |
$57.19
|
| Rate for Payer: United Healthcare HMO Rider |
$55.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.08
|
| Rate for Payer: Vantage Medical Group Senior |
$133.08
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$62,853.31
|
|
|
Service Code
|
APR-DRG 3001
|
| Min. Negotiated Rate |
$50,199.95 |
| Max. Negotiated Rate |
$62,853.31 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50,199.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62,853.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56,237.17
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$150,592.70
|
|
|
Service Code
|
MSDRG 402
|
| Min. Negotiated Rate |
$91,268.30 |
| Max. Negotiated Rate |
$150,592.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$121,885.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$150,592.70
|
| Rate for Payer: EPIC Health Plan Senior |
$100,395.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$91,268.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127,775.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$122,299.52
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$68,835.44
|
|
|
Service Code
|
APR-DRG 3002
|
| Min. Negotiated Rate |
$54,977.78 |
| Max. Negotiated Rate |
$68,835.44 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54,977.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68,835.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61,589.61
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$88,764.14
|
|
|
Service Code
|
APR-DRG 3003
|
| Min. Negotiated Rate |
$70,894.52 |
| Max. Negotiated Rate |
$88,764.14 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70,894.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88,764.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79,420.55
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$168,430.59
|
|
|
Service Code
|
APR-DRG 3004
|
| Min. Negotiated Rate |
$134,522.85 |
| Max. Negotiated Rate |
$168,430.59 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134,522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168,430.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$150,701.06
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$173,822.43
|
|
|
Service Code
|
MSDRG 450
|
| Min. Negotiated Rate |
$105,346.93 |
| Max. Negotiated Rate |
$173,822.43 |
| Rate for Payer: EPIC Health Plan Senior |
$115,881.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161,572.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$173,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$105,346.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147,485.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141,164.89
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$136,572.50
|
|
|
Service Code
|
MSDRG 451
|
| Min. Negotiated Rate |
$82,771.21 |
| Max. Negotiated Rate |
$136,572.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97,932.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$136,572.50
|
| Rate for Payer: EPIC Health Plan Senior |
$91,048.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$82,771.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115,879.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110,913.42
|
|
|
SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$117,755.90
|
|
|
Service Code
|
MSDRG 135
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$117,755.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64,124.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$117,755.90
|
| Rate for Payer: EPIC Health Plan Senior |
$78,503.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$71,367.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99,914.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95,632.06
|
| 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
|
|
|
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$97,265.92
|
|
|
Service Code
|
MSDRG 136
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$97,265.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,779.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,265.92
|
| Rate for Payer: EPIC Health Plan Senior |
$64,843.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,949.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,528.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,991.71
|
| 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
|
|
|
SIPULEUCEL-T IN LACTATED RINGERS 50 MILLION CELL/250 ML IV SUSPENSION [104852]
|
Facility
|
OP
|
$300.49
|
|
|
Service Code
|
HCPCS Q2043
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$400,358.22 |
| Rate for Payer: Cigna of CA HMO |
$210.34
|
| Rate for Payer: Adventist Health Commercial |
$60.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400,358.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83,898.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61,525.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55,932.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79,200.34
|
| Rate for Payer: Blue Shield of California Commercial |
$77,820.00
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cigna of CA PPO |
$210.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69,915.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$61,525.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61,525.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$92,288.51
|
| Rate for Payer: EPIC Health Plan Senior |
$61,525.67
|
| Rate for Payer: Galaxy Health WC |
$255.42
|
| Rate for Payer: Global Benefits Group Commercial |
$180.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$91,729.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55,932.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,932.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103,367.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78,305.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70,474.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,949.46
|
| Rate for Payer: Multiplan Commercial |
$240.39
|
| Rate for Payer: Networks By Design Commercial |
$150.25
|
| Rate for Payer: Prime Health Services Commercial |
$255.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.77
|
| Rate for Payer: United Healthcare All Other HMO |
$109.77
|
| Rate for Payer: United Healthcare HMO Rider |
$107.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$55,932.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69,915.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61,525.67
|
| Rate for Payer: Vantage Medical Group Senior |
$61,525.67
|
|
|
SIPULEUCEL-T IN LACTATED RINGERS 50 MILLION CELL/250 ML IV SUSPENSION [104852]
|
Facility
|
IP
|
$300.49
|
|
|
Service Code
|
HCPCS Q2043
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$255.42 |
| Rate for Payer: Adventist Health Commercial |
$60.10
|
| Rate for Payer: Blue Shield of California Commercial |
$152.35
|
| Rate for Payer: Blue Shield of California Commercial |
$231.08
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cigna of CA HMO |
$210.34
|
| Rate for Payer: Cigna of CA PPO |
$210.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.20
|
| Rate for Payer: EPIC Health Plan Senior |
$120.20
|
| Rate for Payer: Galaxy Health WC |
$255.42
|
| Rate for Payer: Global Benefits Group Commercial |
$180.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.12
|
| Rate for Payer: Multiplan Commercial |
$240.39
|
| Rate for Payer: Networks By Design Commercial |
$150.25
|
| Rate for Payer: Prime Health Services Commercial |
$255.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.77
|
| Rate for Payer: United Healthcare All Other HMO |
$109.77
|
| Rate for Payer: United Healthcare HMO Rider |
$107.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.41
|
|
|
SIROLIMUS 0.5 MG TABLET [104764]
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$44.83 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.83
|
| Rate for Payer: Blue Shield of California Commercial |
$11.77
|
| Rate for Payer: Blue Shield of California Commercial |
$11.77
|
| Rate for Payer: Blue Shield of California Commercial |
$11.77
|
| Rate for Payer: Blue Shield of California Commercial |
$11.77
|
| Rate for Payer: Blue Shield of California Commercial |
$11.77
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna of CA HMO |
$3.66
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$7.25
|
| Rate for Payer: Cigna of CA HMO |
$4.58
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$3.66
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$4.58
|
| Rate for Payer: Cigna of CA PPO |
$7.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$2.62
|
| Rate for Payer: EPIC Health Plan Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Senior |
$4.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$4.45
|
| Rate for Payer: Galaxy Health WC |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Networks By Design Commercial |
$3.27
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Prime Health Services Commercial |
$4.45
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.57
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$3.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2.34
|
| Rate for Payer: United Healthcare HMO Rider |
$3.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4.45
|
|
|
SIROLIMUS 0.5 MG TABLET [104764]
|
Facility
|
IP
|
$5.23
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna of CA HMO |
$3.66
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$7.25
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$4.58
|
| Rate for Payer: Cigna of CA PPO |
$3.66
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$7.25
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$4.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Senior |
$2.62
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$4.45
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.93
|
| Rate for Payer: Global Benefits Group Commercial |
$3.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Multiplan Commercial |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$5.24
|
| Rate for Payer: Networks By Design Commercial |
$3.27
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$5.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.45
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$3.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$3.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1.87
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.39
|
|
