|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$34,204.28
|
|
|
Service Code
|
APR-DRG 3102
|
| Min. Negotiated Rate |
$27,318.41 |
| Max. Negotiated Rate |
$34,204.28 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,318.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34,204.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,603.83
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$51,022.26
|
|
|
Service Code
|
APR-DRG 3103
|
| Min. Negotiated Rate |
$40,750.67 |
| Max. Negotiated Rate |
$51,022.26 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40,750.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51,022.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,651.49
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$24,978.18
|
|
|
Service Code
|
APR-DRG 3101
|
| Min. Negotiated Rate |
$19,949.68 |
| Max. Negotiated Rate |
$24,978.18 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,949.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,978.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,348.90
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$17,666.35
|
|
|
Service Code
|
APR-DRG 1113
|
| Min. Negotiated Rate |
$14,109.84 |
| Max. Negotiated Rate |
$17,666.35 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,109.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,666.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,806.74
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$14,000.93
|
|
|
Service Code
|
APR-DRG 1112
|
| Min. Negotiated Rate |
$11,182.32 |
| Max. Negotiated Rate |
$14,000.93 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,182.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,000.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,527.15
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$40,732.96
|
|
|
Service Code
|
APR-DRG 1114
|
| Min. Negotiated Rate |
$32,532.77 |
| Max. Negotiated Rate |
$40,732.96 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32,532.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,732.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,445.28
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$12,290.59
|
|
|
Service Code
|
APR-DRG 1111
|
| Min. Negotiated Rate |
$9,816.30 |
| Max. Negotiated Rate |
$12,290.59 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,816.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,290.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,996.84
|
|
|
VILAZODONE 20 MG TABLET [109403]
|
Facility
|
IP
|
$1.35
|
|
|
Service Code
|
NDC 7220526130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Senior |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.15
|
|
|
VILAZODONE 20 MG TABLET [109403]
|
Facility
|
OP
|
$6.13
|
|
|
Service Code
|
NDC 6050547733
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.93
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$3.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$5.21
|
|
|
VILAZODONE 20 MG TABLET [109403]
|
Facility
|
IP
|
$6.13
|
|
|
Service Code
|
NDC 6050547733
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4.71
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Multiplan Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
|
|
VILAZODONE 20 MG TABLET [109403]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
NDC 6233223330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
VILAZODONE 20 MG TABLET [109403]
|
Facility
|
OP
|
$1.35
|
|
|
Service Code
|
NDC 7220526130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.87
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Senior |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare HMO Rider |
$0.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1.15
|
|
|
VILAZODONE 20 MG TABLET [109403]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
NDC 6233223330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
|
|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]
|
Facility
|
IP
|
$7.35
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3.73
|
| Rate for Payer: Blue Shield of California Commercial |
$5.65
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cigna of CA HMO |
$5.14
|
| Rate for Payer: Cigna of CA PPO |
$5.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Senior |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$6.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: Multiplan Commercial |
$5.88
|
| Rate for Payer: Networks By Design Commercial |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$6.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.76
|
| Rate for Payer: United Healthcare All Other HMO |
$2.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.41
|
|
|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]
|
Facility
|
OP
|
$7.35
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$32.32 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cigna of CA HMO |
$5.14
|
| Rate for Payer: Cigna of CA PPO |
$5.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Senior |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$6.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$5.88
|
| Rate for Payer: Networks By Design Commercial |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$6.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.76
|
| Rate for Payer: United Healthcare All Other HMO |
$2.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6.25
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]
|
Facility
|
IP
|
$22.37
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$19.01 |
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cigna of CA HMO |
$15.66
|
| Rate for Payer: Cigna of CA PPO |
$15.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.95
|
| Rate for Payer: EPIC Health Plan Senior |
$8.95
|
| Rate for Payer: Galaxy Health WC |
$19.01
|
| Rate for Payer: Global Benefits Group Commercial |
$13.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.37
|
| Rate for Payer: Multiplan Commercial |
$17.90
|
| Rate for Payer: Networks By Design Commercial |
$11.19
|
| Rate for Payer: Prime Health Services Commercial |
$19.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$8.17
|
| Rate for Payer: United Healthcare HMO Rider |
$8.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.33
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]
|
Facility
|
OP
|
$22.37
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$85.45 |
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cigna of CA HMO |
$15.66
|
| Rate for Payer: Cigna of CA PPO |
$15.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.95
|
| Rate for Payer: EPIC Health Plan Senior |
$8.95
|
| Rate for Payer: Galaxy Health WC |
$19.01
|
| Rate for Payer: Global Benefits Group Commercial |
$13.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.66
|
| Rate for Payer: Multiplan Commercial |
$17.90
|
| Rate for Payer: Networks By Design Commercial |
$11.19
|
| Rate for Payer: Prime Health Services Commercial |
$19.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$8.17
|
| Rate for Payer: United Healthcare HMO Rider |
$8.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.01
|
| Rate for Payer: Vantage Medical Group Senior |
$19.01
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [120009]
|
Facility
|
IP
|
$11.36
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Adventist Health Commercial |
$2.27
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Blue Shield of California Commercial |
$8.74
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.95
|
| Rate for Payer: Cigna of CA PPO |
$7.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Senior |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.66
|
| Rate for Payer: Global Benefits Group Commercial |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$9.09
|
| Rate for Payer: Networks By Design Commercial |
$5.68
|
| Rate for Payer: Prime Health Services Commercial |
$9.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Other HMO |
$4.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.72
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [120009]
|
Facility
|
OP
|
$11.36
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$85.45 |
| Rate for Payer: Adventist Health Commercial |
$2.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.95
|
| Rate for Payer: Cigna of CA PPO |
$7.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Senior |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.66
|
| Rate for Payer: Global Benefits Group Commercial |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.95
|
| Rate for Payer: Multiplan Commercial |
$9.09
|
| Rate for Payer: Networks By Design Commercial |
$5.68
|
| Rate for Payer: Prime Health Services Commercial |
$9.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Other HMO |
$4.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.66
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION [14203]
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.21
|
| Rate for Payer: Blue Shield of California Commercial |
$23.07
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Other HMO |
$10.96
|
| Rate for Payer: United Healthcare HMO Rider |
$10.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION [14203]
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$243.59 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.59
|
| Rate for Payer: Blue Shield of California Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Other HMO |
$10.96
|
| Rate for Payer: United Healthcare HMO Rider |
$10.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]
|
Facility
|
IP
|
$21.60
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$10.95
|
| Rate for Payer: Blue Shield of California Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$17.28
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.07
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]
|
Facility
|
OP
|
$21.60
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$243.59 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.59
|
| Rate for Payer: Blue Shield of California Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$17.28
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.36
|
| Rate for Payer: Vantage Medical Group Senior |
$18.36
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$7,999.76
|
|
|
Service Code
|
APR-DRG 7231
|
| Min. Negotiated Rate |
$6,389.28 |
| Max. Negotiated Rate |
$7,999.76 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,389.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,999.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,157.68
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$18,289.04
|
|
|
Service Code
|
APR-DRG 7233
|
| Min. Negotiated Rate |
$14,607.17 |
| Max. Negotiated Rate |
$18,289.04 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,607.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,289.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,363.88
|
|
