|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
IP
|
$6.36
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
1752190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Networks By Design Commercial |
$8.74
|
| 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 Commercial |
$12.44
|
| Rate for Payer: Blue Shield of California EPN |
$3.29
|
| Rate for Payer: Blue Shield of California EPN |
$8.94
|
| Rate for Payer: Blue Shield of California EPN |
$3.26
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA HMO |
$12.23
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| 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: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.57
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$3.86
|
| 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 Commercial/Self Funded |
$11.65
|
| 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: 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 |
$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 |
$3.22
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Prime Health Services Commercial |
$5.47
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
OP
|
$6.43
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
1752190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.54 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.54
|
| 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: BCBS Transplant Transplant |
$3.86
|
| Rate for Payer: BCBS Transplant Transplant |
$10.48
|
| Rate for Payer: BCBS Transplant 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 |
$2.86
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA HMO |
$12.23
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| 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: Dignity Health Commercial/Exchange |
$5.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Media |
$5.41
|
| Rate for Payer: Dignity Health Media |
$5.47
|
| Rate for Payer: Dignity Health Media |
$14.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| 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 |
$14.85
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| 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 Transplant Other |
$13.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.29
|
| 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 Medi-Cal |
$6.66
|
| 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: LLUH Dept of Risk Management WC |
$1.54
|
| 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: 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 |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$8.74
|
| 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 |
$10.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.22
|
| 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 |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.74
|
| 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 |
$14.85
|
| 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 Senior |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.47
|
|
|
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: IEHP Medi-Cal |
$16,896.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,026.38
|
|
|
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: 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: 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: IEHP Medi-Cal |
$47,510.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61,934.55
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| 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
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: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| 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
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
|
|
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$280.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$181.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$181.27
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
$25,381.76
|
|
|
Service Code
|
APR-DRG 2263
|
| Min. Negotiated Rate |
$19,470.48 |
| Max. Negotiated Rate |
$25,381.76 |
| Rate for Payer: IEHP Medi-Cal |
$19,470.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,381.76
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
IP
|
$17,300.11
|
|
|
Service Code
|
APR-DRG 2262
|
| Min. Negotiated Rate |
$13,271.00 |
| Max. Negotiated Rate |
$17,300.11 |
| Rate for Payer: IEHP Medi-Cal |
$13,271.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,300.11
|
|
|
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: IEHP Medi-Cal |
$10,029.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,073.94
|
|
|
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: IEHP Medi-Cal |
$32,546.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42,428.25
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
OP
|
$1.09
|
|
|
Service Code
|
CPT S0170
|
| Hospital Charge Code |
1711729
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$36.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.61
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Media |
$0.93
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
CPT S0170
|
| Hospital Charge Code |
1711729
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
IP
|
$20,341.59
|
|
|
Service Code
|
APR-DRG 1984
|
| Min. Negotiated Rate |
$15,604.14 |
| Max. Negotiated Rate |
$20,341.59 |
| Rate for Payer: IEHP Medi-Cal |
$15,604.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,341.59
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
IP
|
$11,699.52
|
|
|
Service Code
|
APR-DRG 1983
|
| Min. Negotiated Rate |
$8,974.76 |
| Max. Negotiated Rate |
$11,699.52 |
| Rate for Payer: IEHP Medi-Cal |
$8,974.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,699.52
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
IP
|
$8,867.30
|
|
|
Service Code
|
APR-DRG 1982
|
| Min. Negotiated Rate |
$6,802.15 |
| Max. Negotiated Rate |
$8,867.30 |
| Rate for Payer: IEHP Medi-Cal |
$6,802.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,867.30
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
IP
|
$7,420.16
|
|
|
Service Code
|
APR-DRG 1981
|
| Min. Negotiated Rate |
$5,692.05 |
| Max. Negotiated Rate |
$7,420.16 |
| Rate for Payer: IEHP Medi-Cal |
$5,692.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,420.16
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
NDG220829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,180.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,072.44
|
| Rate for Payer: BCBS Transplant Transplant |
$1,080.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,326.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,051.20
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Dignity Health Media |
$1,530.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.00
|
| Rate for Payer: United Healthcare All Other HMO |
$900.00
|
| Rate for Payer: United Healthcare HMO Rider |
$900.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$900.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,530.00
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
NDG220829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Blue Shield of California Commercial |
$1,281.60
|
| Rate for Payer: Blue Shield of California EPN |
$921.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
IP
|
$229.07
|
|
|
Service Code
|
CPT J0348
|
| Hospital Charge Code |
1753552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.98 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Blue Shield of California Commercial |
$163.10
|
| Rate for Payer: Blue Shield of California EPN |
$117.28
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.98
|
| Rate for Payer: Multiplan Commercial |
$183.26
|
| Rate for Payer: Networks By Design Commercial |
$114.54
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
|
