|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS
|
Facility
|
IP
|
$25,459.35
|
|
|
Service Code
|
APR-DRG 3854
|
| Min. Negotiated Rate |
$16,079.59 |
| Max. Negotiated Rate |
$25,459.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,079.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,161.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,459.35
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC
|
Facility
|
IP
|
$45,479.23
|
|
|
Service Code
|
MSDRG 580
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$45,479.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,479.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,377.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,129.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$40,811.51
|
| Rate for Payer: EPIC Health Plan Senior |
$27,207.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,734.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,627.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,143.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,734.25
|
| Rate for Payer: Prime Health Services Medicare |
$26,218.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC
|
Facility
|
IP
|
$85,234.08
|
|
|
Service Code
|
MSDRG 579
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$85,234.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85,234.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55,057.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77,082.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$75,185.76
|
| Rate for Payer: EPIC Health Plan Senior |
$50,123.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$45,567.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63,793.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61,059.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$45,567.13
|
| Rate for Payer: Prime Health Services Medicare |
$48,301.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,980.95
|
|
|
Service Code
|
MSDRG 581
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$37,980.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,980.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,534.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,348.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,328.07
|
| Rate for Payer: EPIC Health Plan Senior |
$22,885.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,804.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,126.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,878.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,804.89
|
| Rate for Payer: Prime Health Services Medicare |
$22,053.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
|
IP
|
$11,956.23
|
|
|
Service Code
|
APR-DRG 3641
|
| Min. Negotiated Rate |
$7,551.30 |
| Max. Negotiated Rate |
$11,956.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,551.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,998.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,956.23
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
|
IP
|
$16,127.62
|
|
|
Service Code
|
APR-DRG 3642
|
| Min. Negotiated Rate |
$10,185.86 |
| Max. Negotiated Rate |
$16,127.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,185.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,138.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,127.62
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
|
IP
|
$26,180.44
|
|
|
Service Code
|
APR-DRG 3643
|
| Min. Negotiated Rate |
$16,535.02 |
| Max. Negotiated Rate |
$26,180.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,535.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,704.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,180.44
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
|
IP
|
$44,406.84
|
|
|
Service Code
|
APR-DRG 3644
|
| Min. Negotiated Rate |
$28,046.42 |
| Max. Negotiated Rate |
$44,406.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$28,046.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33,421.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44,406.84
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$58,558.55
|
|
|
Service Code
|
APR-DRG 2234
|
| Min. Negotiated Rate |
$36,984.35 |
| Max. Negotiated Rate |
$58,558.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$36,984.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44,073.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58,558.55
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$33,649.06
|
|
|
Service Code
|
APR-DRG 2233
|
| Min. Negotiated Rate |
$21,252.04 |
| Max. Negotiated Rate |
$33,649.06 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,252.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,325.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,649.06
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$19,040.15
|
|
|
Service Code
|
APR-DRG 2231
|
| Min. Negotiated Rate |
$12,025.36 |
| Max. Negotiated Rate |
$19,040.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,025.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,330.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,040.15
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$23,551.92
|
|
|
Service Code
|
APR-DRG 2232
|
| Min. Negotiated Rate |
$14,874.90 |
| Max. Negotiated Rate |
$23,551.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,874.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,725.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,551.92
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$60,637.19
|
|
|
Service Code
|
APR-DRG 2224
|
| Min. Negotiated Rate |
$38,297.17 |
| Max. Negotiated Rate |
$60,637.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,297.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45,637.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60,637.19
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$12,163.69
|
|
|
Service Code
|
APR-DRG 2221
|
| Min. Negotiated Rate |
$7,682.33 |
| Max. Negotiated Rate |
$12,163.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,682.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,154.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,163.69
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$21,580.03
|
|
|
Service Code
|
APR-DRG 2222
|
| Min. Negotiated Rate |
$13,629.49 |
| Max. Negotiated Rate |
$21,580.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,629.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,241.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,580.03
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$33,556.41
|
|
|
Service Code
|
APR-DRG 2223
|
| Min. Negotiated Rate |
$21,193.52 |
| Max. Negotiated Rate |
$33,556.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,193.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,255.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,556.41
|
|
|
OTHER VASCULAR PROCEDURES WITH CC
|
Facility
|
IP
|
$68,313.60
|
|
|
Service Code
|
MSDRG 253
|
| Min. Negotiated Rate |
$25,651.00 |
| Max. Negotiated Rate |
$68,313.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68,313.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44,127.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61,780.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$60,555.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40,370.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,700.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51,380.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49,178.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$36,700.23
|
| Rate for Payer: Prime Health Services Medicare |
$38,902.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,936.00
|
| Rate for Payer: United Healthcare All Other HMO |
$43,936.00
|
| Rate for Payer: United Healthcare HMO Rider |
$29,046.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26,610.00
|
|
|
OTHER VASCULAR PROCEDURES WITH MCC
|
Facility
|
IP
|
$91,808.57
|
|
|
Service Code
|
MSDRG 252
|
| Min. Negotiated Rate |
$25,651.00 |
| Max. Negotiated Rate |
$91,808.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$91,808.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59,304.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83,028.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$80,870.44
|
| Rate for Payer: EPIC Health Plan Senior |
$53,913.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49,012.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68,617.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65,676.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49,012.39
|
| Rate for Payer: Prime Health Services Medicare |
$51,953.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,180.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42,180.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,795.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29,128.00
|
|
|
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$56,697.00
|
|
|
Service Code
|
MSDRG 254
|
| Min. Negotiated Rate |
$19,823.00 |
| Max. Negotiated Rate |
$56,697.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,892.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30,290.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42,408.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,033.60
|
| Rate for Payer: EPIC Health Plan Senior |
$28,022.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,474.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,664.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34,136.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,474.91
|
| Rate for Payer: Prime Health Services Medicare |
$27,003.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$56,697.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56,697.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21,636.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,823.00
|
|
|
OTITIS MEDIA AND URI WITH MCC
|
Facility
|
IP
|
$31,114.32
|
|
|
Service Code
|
MSDRG 152
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$31,114.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,114.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,098.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,138.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,390.81
|
| Rate for Payer: EPIC Health Plan Senior |
$18,927.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,206.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,089.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,056.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,206.55
|
| Rate for Payer: Prime Health Services Medicare |
$18,238.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
OTITIS MEDIA AND URI WITHOUT MCC
|
Facility
|
IP
|
$19,428.69
|
|
|
Service Code
|
MSDRG 153
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$19,428.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,428.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,550.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,570.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,286.77
|
| Rate for Payer: EPIC Health Plan Senior |
$12,191.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,082.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,516.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,851.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,082.89
|
| Rate for Payer: Prime Health Services Medicare |
$11,747.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
|
IP
|
$140.16
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$126.14 |
| Rate for Payer: Adventist Health Commercial |
$28.03
|
| Rate for Payer: Adventist Health Commercial |
$26.64
|
| Rate for Payer: Blue Shield of California Commercial |
$112.41
|
| Rate for Payer: Blue Shield of California Commercial |
$106.83
|
| Rate for Payer: Blue Shield of California EPN |
$67.13
|
| Rate for Payer: Blue Shield of California EPN |
$70.64
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Central Health Plan Commercial |
$112.13
|
| Rate for Payer: Central Health Plan Commercial |
$106.56
|
| Rate for Payer: Cigna of CA HMO |
$93.24
|
| Rate for Payer: Cigna of CA HMO |
$98.11
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$98.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.06
|
| Rate for Payer: EPIC Health Plan Senior |
$53.28
|
| Rate for Payer: EPIC Health Plan Senior |
$56.06
|
| Rate for Payer: Galaxy Health WC |
$119.14
|
| Rate for Payer: Galaxy Health WC |
$113.22
|
| Rate for Payer: Global Benefits Group Commercial |
$79.92
|
| Rate for Payer: Global Benefits Group Commercial |
$84.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.64
|
| Rate for Payer: Multiplan Commercial |
$99.90
|
| Rate for Payer: Multiplan Commercial |
$105.12
|
| Rate for Payer: Networks By Design Commercial |
$66.60
|
| Rate for Payer: Networks By Design Commercial |
$70.08
|
| Rate for Payer: Prime Health Services Commercial |
$119.14
|
| Rate for Payer: Prime Health Services Commercial |
$113.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.60
|
| Rate for Payer: United Healthcare All Other HMO |
$51.20
|
| Rate for Payer: United Healthcare All Other HMO |
$48.66
|
| Rate for Payer: United Healthcare HMO Rider |
$47.61
|
| Rate for Payer: United Healthcare HMO Rider |
$50.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.90
|
|
|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
|
OP
|
$133.20
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$119.88 |
| Rate for Payer: Adventist Health Commercial |
$26.64
|
| Rate for Payer: Adventist Health Commercial |
$28.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.15
|
| Rate for Payer: Blue Shield of California EPN |
$2.86
|
| Rate for Payer: Blue Shield of California EPN |
$2.86
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Central Health Plan Commercial |
$106.56
|
| Rate for Payer: Central Health Plan Commercial |
$112.13
|
| Rate for Payer: Cigna of CA HMO |
$93.24
|
| Rate for Payer: Cigna of CA HMO |
$98.11
|
| Rate for Payer: Cigna of CA PPO |
$98.11
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.06
|
| Rate for Payer: EPIC Health Plan Senior |
$53.28
|
| Rate for Payer: EPIC Health Plan Senior |
$56.06
|
| Rate for Payer: Galaxy Health WC |
$119.14
|
| Rate for Payer: Galaxy Health WC |
$113.22
|
| Rate for Payer: Global Benefits Group Commercial |
$79.92
|
| Rate for Payer: Global Benefits Group Commercial |
$84.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$93.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.11
|
| Rate for Payer: Multiplan Commercial |
$105.12
|
| Rate for Payer: Multiplan Commercial |
$99.90
|
| Rate for Payer: Networks By Design Commercial |
$70.08
|
| Rate for Payer: Networks By Design Commercial |
$66.60
|
| Rate for Payer: Prime Health Services Commercial |
$113.22
|
| Rate for Payer: Prime Health Services Commercial |
$119.14
|
| Rate for Payer: Riverside University Health System MISP |
$56.06
|
| Rate for Payer: Riverside University Health System MISP |
$53.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.60
|
| Rate for Payer: United Healthcare All Other HMO |
$51.20
|
| Rate for Payer: United Healthcare All Other HMO |
$48.66
|
| Rate for Payer: United Healthcare HMO Rider |
$47.61
|
| Rate for Payer: United Healthcare HMO Rider |
$50.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.14
|
| Rate for Payer: Vantage Medical Group Senior |
$119.14
|
| Rate for Payer: Vantage Medical Group Senior |
$113.22
|
|
|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
|
IP
|
$9.95
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$7.98
|
| Rate for Payer: Blue Shield of California Commercial |
$10.88
|
| Rate for Payer: Blue Shield of California EPN |
$6.83
|
| Rate for Payer: Blue Shield of California EPN |
$5.01
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.96
|
| Rate for Payer: Central Health Plan Commercial |
$10.85
|
| Rate for Payer: Cigna of CA HMO |
$9.49
|
| Rate for Payer: Cigna of CA HMO |
$6.96
|
| Rate for Payer: Cigna of CA PPO |
$9.49
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Senior |
$5.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$11.53
|
| Rate for Payer: Global Benefits Group Commercial |
$8.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$7.46
|
| Rate for Payer: Networks By Design Commercial |
$6.78
|
| Rate for Payer: Networks By Design Commercial |
$4.97
|
| Rate for Payer: Prime Health Services Commercial |
$8.46
|
| Rate for Payer: Prime Health Services Commercial |
$11.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare All Other HMO |
$4.95
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
|
|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
|
OP
|
$13.56
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.15
|
| Rate for Payer: Blue Shield of California EPN |
$2.86
|
| Rate for Payer: Blue Shield of California EPN |
$2.86
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Central Health Plan Commercial |
$10.85
|
| Rate for Payer: Central Health Plan Commercial |
$7.96
|
| Rate for Payer: Cigna of CA HMO |
$9.49
|
| Rate for Payer: Cigna of CA HMO |
$6.96
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Cigna of CA PPO |
$9.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Senior |
$5.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$11.53
|
| Rate for Payer: Global Benefits Group Commercial |
$8.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.96
|
| Rate for Payer: Multiplan Commercial |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$10.17
|
| Rate for Payer: Networks By Design Commercial |
$4.97
|
| Rate for Payer: Networks By Design Commercial |
$6.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$8.46
|
| Rate for Payer: Riverside University Health System MISP |
$3.98
|
| Rate for Payer: Riverside University Health System MISP |
$5.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare All Other HMO |
$4.95
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
