|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
|
OP
|
$16.08
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$13.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Blue Distinction Transplant |
$9.65
|
| Rate for Payer: Blue Distinction Transplant |
$5.12
|
| Rate for Payer: Blue Shield of California Commercial |
$11.85
|
| Rate for Payer: Blue Shield of California Commercial |
$6.29
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cigna of CA HMO |
$11.26
|
| Rate for Payer: Cigna of CA HMO |
$5.97
|
| Rate for Payer: Cigna of CA PPO |
$11.26
|
| Rate for Payer: Cigna of CA PPO |
$5.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.67
|
| Rate for Payer: Dignity Health Media |
$7.25
|
| Rate for Payer: Dignity Health Media |
$13.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$13.67
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Global Benefits Group Commercial |
$9.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$4.26
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: Prime Health Services Commercial |
$13.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Other HMO |
$4.26
|
| Rate for Payer: United Healthcare All Other HMO |
$8.04
|
| Rate for Payer: United Healthcare HMO Rider |
$4.26
|
| Rate for Payer: United Healthcare HMO Rider |
$8.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$13.67
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
|
IP
|
$16.08
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$13.67 |
| Rate for Payer: Blue Shield of California Commercial |
$11.45
|
| Rate for Payer: Blue Shield of California Commercial |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$8.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.37
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$11.26
|
| Rate for Payer: Cigna of CA HMO |
$5.97
|
| Rate for Payer: Cigna of CA PPO |
$5.97
|
| Rate for Payer: Cigna of CA PPO |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$13.67
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Global Benefits Group Commercial |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$4.26
|
| Rate for Payer: Prime Health Services Commercial |
$13.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.22
|
| Rate for Payer: United Healthcare All Other HMO |
$5.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$5.80
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.81
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 0781-2145-01
|
| Hospital Charge Code |
1710493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 0781-2145-01
|
| Hospital Charge Code |
1710493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Blue Distinction Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Media |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Blue Distinction Transplant |
$2.16
|
| Rate for Payer: Blue Distinction Transplant |
$2.03
|
| Rate for Payer: Blue Distinction Transplant |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Media |
$2.87
|
| Rate for Payer: Dignity Health Media |
$2.41
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$2.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare HMO Rider |
$1.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Blue Shield of California Commercial |
$47.42
|
| Rate for Payer: Blue Shield of California Commercial |
$62.21
|
| Rate for Payer: Blue Shield of California EPN |
$34.10
|
| Rate for Payer: Blue Shield of California EPN |
$44.73
|
| Rate for Payer: Cash Price |
$29.97
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cigna of CA HMO |
$46.62
|
| Rate for Payer: Cigna of CA HMO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$46.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.95
|
| Rate for Payer: Galaxy Health WC |
$56.61
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Global Benefits Group Commercial |
$39.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$53.28
|
| Rate for Payer: Multiplan Commercial |
$69.90
|
| Rate for Payer: Networks By Design Commercial |
$33.30
|
| Rate for Payer: Networks By Design Commercial |
$43.68
|
| Rate for Payer: Prime Health Services Commercial |
$56.61
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.99
|
| Rate for Payer: United Healthcare All Other HMO |
$24.56
|
| Rate for Payer: United Healthcare All Other HMO |
$32.22
|
| Rate for Payer: United Healthcare HMO Rider |
$24.03
|
| Rate for Payer: United Healthcare HMO Rider |
$31.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.83
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
|
OP
|
$87.37
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$74.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Blue Distinction Transplant |
$52.42
|
| Rate for Payer: Blue Distinction Transplant |
$39.96
|
| Rate for Payer: Blue Shield of California Commercial |
$49.08
|
| Rate for Payer: Blue Shield of California Commercial |
$64.39
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Cash Price |
$29.97
|
| Rate for Payer: Cash Price |
$29.97
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cigna of CA HMO |
$61.16
|
| Rate for Payer: Cigna of CA HMO |
$46.62
|
| Rate for Payer: Cigna of CA PPO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$46.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.26
|
| Rate for Payer: Dignity Health Media |
$74.26
|
| Rate for Payer: Dignity Health Media |
$56.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.95
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Galaxy Health WC |
$56.61
|
| Rate for Payer: Global Benefits Group Commercial |
$39.96
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$49.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$69.90
|
| Rate for Payer: Multiplan Commercial |
$53.28
|
| Rate for Payer: Networks By Design Commercial |
$33.30
|
| Rate for Payer: Networks By Design Commercial |
$43.68
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
| Rate for Payer: Prime Health Services Commercial |
$56.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.68
|
| Rate for Payer: United Healthcare All Other HMO |
$43.68
|
| Rate for Payer: United Healthcare All Other HMO |
$33.30
|
| Rate for Payer: United Healthcare HMO Rider |
$43.68
|
| Rate for Payer: United Healthcare HMO Rider |
$33.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.26
|
| Rate for Payer: Vantage Medical Group Senior |
$74.26
|
| Rate for Payer: Vantage Medical Group Senior |
$56.61
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [32470]
|
Facility
|
OP
|
$9.25
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$14.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Blue Distinction Transplant |
$3.96
|
| Rate for Payer: Blue Distinction Transplant |
$2.80
|
| Rate for Payer: Blue Distinction Transplant |
$1.96
|
| Rate for Payer: Blue Distinction Transplant |
$5.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$6.82
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cigna of CA HMO |
$6.48
|
| Rate for Payer: Cigna of CA HMO |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$3.27
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$3.27
|
| Rate for Payer: Cigna of CA PPO |
$2.29
|
| Rate for Payer: Cigna of CA PPO |
$6.48
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.78
|
| Rate for Payer: Dignity Health Media |
$2.78
|
| Rate for Payer: Dignity Health Media |
$7.86
|
| Rate for Payer: Dignity Health Media |
$3.97
|
| Rate for Payer: Dignity Health Media |
$5.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.70
|
| Rate for Payer: Galaxy Health WC |
$7.86
|
| Rate for Payer: Galaxy Health WC |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$5.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Prime Health Services Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2.34
|
| Rate for Payer: United Healthcare All Other HMO |
$3.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.62
|
| Rate for Payer: United Healthcare HMO Rider |
$3.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3.97
|
| Rate for Payer: Vantage Medical Group Senior |
$7.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.78
|
| Rate for Payer: Vantage Medical Group Senior |
$5.61
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [32470]
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California Commercial |
$6.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California Commercial |
$4.70
|
| Rate for Payer: Blue Shield of California EPN |
$4.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$3.27
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA HMO |
$6.48
|
| Rate for Payer: Cigna of CA HMO |
$2.29
|
| Rate for Payer: Cigna of CA PPO |
$2.29
|
| Rate for Payer: Cigna of CA PPO |
$6.48
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.64
|
| Rate for Payer: Galaxy Health WC |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$7.86
|
| Rate for Payer: Global Benefits Group Commercial |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$7.40
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$3.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.54
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
1752190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$14.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Blue Distinction Transplant |
$3.86
|
| Rate for Payer: Blue Distinction Transplant |
$10.48
|
| Rate for Payer: Blue Distinction Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California Commercial |
$12.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.74
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA HMO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$4.50
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$12.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.85
|
| Rate for Payer: Dignity Health Media |
$14.85
|
| Rate for Payer: Dignity Health Media |
$5.41
|
| Rate for Payer: Dignity Health Media |
$5.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.57
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3.86
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$13.98
|
| Rate for Payer: Multiplan Commercial |
$5.09
|
| Rate for Payer: Networks By Design Commercial |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$8.74
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Prime Health Services Commercial |
$5.47
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Other HMO |
$3.22
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$8.74
|
| Rate for Payer: United Healthcare HMO Rider |
$8.74
|
| Rate for Payer: United Healthcare HMO Rider |
$3.22
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.47
|
| Rate for Payer: Vantage Medical Group Senior |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
IP
|
$17.47
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
1752190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Blue Shield of California Commercial |
$12.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4.58
|
| Rate for Payer: Blue Shield of California EPN |
$3.26
|
| Rate for Payer: Blue Shield of California EPN |
$3.29
|
| Rate for Payer: Blue Shield of California EPN |
$8.94
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA HMO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$4.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$3.86
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$13.98
|
| Rate for Payer: Multiplan Commercial |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$5.14
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$8.74
|
| Rate for Payer: Networks By Design Commercial |
$3.22
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$5.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.35
|
| Rate for Payer: United Healthcare All Other HMO |
$6.44
|
| Rate for Payer: United Healthcare All Other HMO |
$2.37
|
| Rate for Payer: United Healthcare HMO Rider |
$2.32
|
| Rate for Payer: United Healthcare HMO Rider |
$6.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.12
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$33,362.33
|
|
|
Service Code
|
APR-DRG 3053
|
| Min. Negotiated Rate |
$25,592.42 |
| Max. Negotiated Rate |
$33,362.33 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,592.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,362.33
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$16,519.78
|
|
|
Service Code
|
APR-DRG 3051
|
| Min. Negotiated Rate |
$12,672.41 |
| Max. Negotiated Rate |
$16,519.78 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,672.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,519.78
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$61,934.55
|
|
|
Service Code
|
APR-DRG 3054
|
| Min. Negotiated Rate |
$47,510.32 |
| Max. Negotiated Rate |
$61,934.55 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47,510.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61,934.55
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$22,026.38
|
|
|
Service Code
|
APR-DRG 3052
|
| Min. Negotiated Rate |
$16,896.55 |
| Max. Negotiated Rate |
$22,026.38 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16,896.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,026.38
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 0172-5241-60
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 0172-5241-60
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Distinction Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Media |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Distinction Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Media |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
IP
|
$329.59
|
|
|
Service Code
|
CPT J3590
|
| Hospital Charge Code |
1712540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$280.15 |
| Rate for Payer: Blue Shield of California Commercial |
$234.67
|
| Rate for Payer: Blue Shield of California EPN |
$168.75
|
| Rate for Payer: Cash Price |
$148.32
|
| Rate for Payer: Cigna of CA HMO |
$230.71
|
| Rate for Payer: Cigna of CA PPO |
$230.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$131.84
|
| Rate for Payer: Galaxy Health WC |
$280.15
|
| Rate for Payer: Global Benefits Group Commercial |
$197.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.10
|
| Rate for Payer: Multiplan Commercial |
$263.67
|
| Rate for Payer: Networks By Design Commercial |
$164.80
|
| Rate for Payer: Prime Health Services Commercial |
$280.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.45
|
| Rate for Payer: United Healthcare All Other HMO |
$121.55
|
| Rate for Payer: United Healthcare HMO Rider |
$118.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.76
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
OP
|
$329.59
|
|
|
Service Code
|
CPT J3590
|
| Hospital Charge Code |
1712540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$280.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$216.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.27
|
| Rate for Payer: Blue Distinction Transplant |
$197.75
|
| Rate for Payer: Blue Shield of California Commercial |
$242.91
|
| Rate for Payer: Blue Shield of California EPN |
$192.48
|
| Rate for Payer: Cash Price |
$148.32
|
| Rate for Payer: Cigna of CA HMO |
$230.71
|
| Rate for Payer: Cigna of CA PPO |
$230.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.15
|
| Rate for Payer: Dignity Health Media |
$280.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$131.84
|
| Rate for Payer: Galaxy Health WC |
$280.15
|
| Rate for Payer: Global Benefits Group Commercial |
$197.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$247.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.10
|
| Rate for Payer: Multiplan Commercial |
$263.67
|
| Rate for Payer: Networks By Design Commercial |
$164.80
|
| Rate for Payer: Prime Health Services Commercial |
$280.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$197.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$197.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.80
|
| Rate for Payer: United Healthcare All Other HMO |
$164.80
|
| Rate for Payer: United Healthcare HMO Rider |
$164.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.15
|
| Rate for Payer: Vantage Medical Group Senior |
$280.15
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$42,428.25
|
|
|
Service Code
|
APR-DRG 2264
|
| Min. Negotiated Rate |
$32,546.94 |
| Max. Negotiated Rate |
$42,428.25 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32,546.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42,428.25
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$25,381.76
|
|
|
Service Code
|
APR-DRG 2263
|
| Min. Negotiated Rate |
$19,470.48 |
| Max. Negotiated Rate |
$25,381.76 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,470.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,381.76
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$13,073.94
|
|
|
Service Code
|
APR-DRG 2261
|
| Min. Negotiated Rate |
$10,029.09 |
| Max. Negotiated Rate |
$13,073.94 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,029.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,073.94
|
|
