|
Outdated MS-DRG 343
|
Facility
IP
|
$23,490.88
|
|
|
Service Code
|
MS-DRG 343
|
| Min. Negotiated Rate |
$18,576.99 |
| Max. Negotiated Rate |
$23,490.88 |
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18,576.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,818.85
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$23,021.06
|
| Rate for Payer: Multiplan WC |
$23,021.06
|
| Rate for Payer: Preferred Health Network WC |
$23,490.88
|
| Rate for Payer: Prime Health Services WC |
$22,786.15
|
|
|
Outdated MS-DRG 691
|
Facility
IP
|
$7,890.00
|
|
|
Service Code
|
MS-DRG 691
|
| Min. Negotiated Rate |
$6,240.00 |
| Max. Negotiated Rate |
$7,890.00 |
| Rate for Payer: Cigna of CA HMO |
$6,240.00
|
| Rate for Payer: Cigna of CA PPO |
$7,890.00
|
|
|
Outdated MS-DRG 692
|
Facility
IP
|
$7,890.00
|
|
|
Service Code
|
MS-DRG 692
|
| Min. Negotiated Rate |
$6,240.00 |
| Max. Negotiated Rate |
$7,890.00 |
| Rate for Payer: Cigna of CA HMO |
$6,240.00
|
| Rate for Payer: Cigna of CA PPO |
$7,890.00
|
|
|
Outdated MS-DRG 765
|
Facility
IP
|
$16,694.00
|
|
|
Service Code
|
MS-DRG 765
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$16,694.00 |
| Rate for Payer: Cigna of CA HMO |
$5,000.00
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,694.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,719.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,206.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,332.00
|
|
|
Outdated MS-DRG 766
|
Facility
IP
|
$16,694.00
|
|
|
Service Code
|
MS-DRG 766
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$16,694.00 |
| Rate for Payer: Cigna of CA HMO |
$5,000.00
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,694.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,719.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,206.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,332.00
|
|
|
Outdated MS-DRG 767
|
Facility
IP
|
$10,210.00
|
|
|
Service Code
|
MS-DRG 767
|
| Min. Negotiated Rate |
$4,760.00 |
| Max. Negotiated Rate |
$10,210.00 |
| Rate for Payer: Cigna of CA HMO |
$4,760.00
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,461.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,977.00
|
|
|
Outdated MS-DRG 774
|
Facility
IP
|
$10,210.00
|
|
|
Service Code
|
MS-DRG 774
|
| Min. Negotiated Rate |
$4,760.00 |
| Max. Negotiated Rate |
$10,210.00 |
| Rate for Payer: Cigna of CA HMO |
$4,760.00
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,461.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,977.00
|
|
|
Outdated MS-DRG 775
|
Facility
IP
|
$10,210.00
|
|
|
Service Code
|
MS-DRG 775
|
| Min. Negotiated Rate |
$4,760.00 |
| Max. Negotiated Rate |
$10,210.00 |
| Rate for Payer: Cigna of CA HMO |
$4,760.00
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,461.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,977.00
|
|
|
Outdated MS-DRG 780
|
Facility
IP
|
$4,847.00
|
|
|
Service Code
|
MS-DRG 780
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$4,847.00 |
| Rate for Payer: United Healthcare All Other Commercial |
$4,847.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,623.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,128.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,860.00
|
|
|
Ovarian cystectomy, unilateral or bilateral
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 58925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,214.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$6,214.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,389.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,214.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,191.89
|
| Rate for Payer: IEHP medi-cal |
$10,254.04
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Innovage PACE Commercial |
$9,321.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,214.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,327.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,327.52
|
| Rate for Payer: Prime Health Services Medicare |
$6,587.44
|
| Rate for Payer: Riverside University Health MISP |
$6,836.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
IP
|
$140.16
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
ERX5925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$126.14 |
| Rate for Payer: Blue Shield of California Commercial |
$105.12
|
| Rate for Payer: Blue Shield of California Commercial |
$99.90
|
| Rate for Payer: Blue Shield of California EPN |
$74.85
|
| Rate for Payer: Blue Shield of California EPN |
$71.13
|
| Rate for Payer: Cash Price |
$63.07
|
| 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: EPIC Health Plan Commercial |
$53.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.28
|
| Rate for Payer: Galaxy Health WC |
$113.22
|
| Rate for Payer: Galaxy Health WC |
$119.14
|
| 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 |
$126.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.49
|
| 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
|
|
|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
OP
|
$140.16
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
ERX5925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$126.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$113.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$73.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.26
|
| 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 |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.18
|
| Rate for Payer: BCBS Transplant Transplant |
$84.10
|
| Rate for Payer: BCBS Transplant Transplant |
$79.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cash Price |
$63.07
|
| 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 |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$98.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.28
|
| 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 |
$126.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$99.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$105.12
|
| Rate for Payer: IEHP medi-cal |
$0.94
|
| Rate for Payer: IEHP medi-cal |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.03
|
| 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 MISP |
$56.06
|
| Rate for Payer: Riverside University Health 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 |
$70.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.60
|
| Rate for Payer: United Healthcare All Other HMO |
$66.60
|
| Rate for Payer: United Healthcare All Other HMO |
$70.08
|
| Rate for Payer: United Healthcare HMO Rider |
$66.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.08
|
| 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 |
$113.22
|
| Rate for Payer: Vantage Medical Group Senior |
$119.14
|
|
|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
OP
|
$9.95
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.47
|
| 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 Exchange |
$5.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.18
|
| Rate for Payer: BCBS Transplant Transplant |
$8.10
|
| Rate for Payer: BCBS Transplant Transplant |
$5.97
|
| Rate for Payer: BCBS Transplant Transplant |
$8.14
|
| Rate for Payer: BCBS Transplant Transplant |
$8.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$7.96
|
| Rate for Payer: Central Health Plan Commercial |
$11.21
|
| 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 |
$9.81
|
| Rate for Payer: Cigna of CA HMO |
$6.96
|
| Rate for Payer: Cigna of CA HMO |
$9.45
|
| Rate for Payer: Cigna of CA PPO |
$9.81
|
| Rate for Payer: Cigna of CA PPO |
$9.49
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$11.48
|
| Rate for Payer: Global Benefits Group Commercial |
$8.41
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| 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: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.12
|
| Rate for Payer: IEHP medi-cal |
$0.94
|
| Rate for Payer: IEHP medi-cal |
$0.94
|
| Rate for Payer: IEHP medi-cal |
$0.94
|
| Rate for Payer: IEHP medi-cal |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$10.17
|
| Rate for Payer: Networks By Design Commercial |
$7.00
|
| Rate for Payer: Networks By Design Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$6.78
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Prime Health Services Commercial |
$11.91
|
| Rate for Payer: Prime Health Services Commercial |
$8.46
|
| Rate for Payer: Prime Health Services Commercial |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.48
|
| Rate for Payer: Riverside University Health MISP |
$3.98
|
| Rate for Payer: Riverside University Health MISP |
$5.42
|
| Rate for Payer: Riverside University Health MISP |
$5.40
|
| Rate for Payer: Riverside University Health MISP |
$5.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.10
|
| 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 |
$4.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.78
|
| Rate for Payer: United Healthcare All Other HMO |
$7.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.78
|
| Rate for Payer: United Healthcare All Other HMO |
$6.75
|
| Rate for Payer: United Healthcare All Other HMO |
$4.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6.75
|
| Rate for Payer: United Healthcare HMO Rider |
$7.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.48
|
| 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 |
$11.91
|
| Rate for Payer: Vantage Medical Group Senior |
$11.48
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
IP
|
$13.56
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Blue Shield of California Commercial |
$10.17
|
| Rate for Payer: Blue Shield of California Commercial |
$10.12
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California Commercial |
$7.46
|
| Rate for Payer: Blue Shield of California EPN |
$7.24
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$5.31
|
| Rate for Payer: Blue Shield of California EPN |
$7.48
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Central Health Plan Commercial |
$11.21
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| 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 HMO |
$9.81
|
| Rate for Payer: Cigna of CA HMO |
$9.45
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Cigna of CA PPO |
$9.49
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: Cigna of CA PPO |
$9.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.40
|
| Rate for Payer: Galaxy Health WC |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$8.46
|
| Rate for Payer: Global Benefits Group Commercial |
$8.14
|
| Rate for Payer: Global Benefits Group Commercial |
$8.41
|
| Rate for Payer: Global Benefits Group Commercial |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$10.17
|
| Rate for Payer: Networks By Design Commercial |
$6.78
|
| Rate for Payer: Networks By Design Commercial |
$7.00
|
| Rate for Payer: Networks By Design Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Prime Health Services Commercial |
$11.91
|
| Rate for Payer: Prime Health Services Commercial |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.48
|
| Rate for Payer: Prime Health Services Commercial |
$8.46
|
|
|
OXACILLIN 2 GRAM SOLUTION FOR INJECTION [5926]
|
Facility
IP
|
$27.12
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$24.41 |
| Rate for Payer: Blue Shield of California Commercial |
$20.34
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California Commercial |
$21.02
|
| Rate for Payer: Blue Shield of California EPN |
$14.48
|
| Rate for Payer: Blue Shield of California EPN |
$10.63
|
| Rate for Payer: Blue Shield of California EPN |
$14.97
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Central Health Plan Commercial |
$22.42
|
| Rate for Payer: Central Health Plan Commercial |
$15.92
|
| Rate for Payer: Central Health Plan Commercial |
$21.70
|
| Rate for Payer: Cigna of CA HMO |
$13.93
|
| Rate for Payer: Cigna of CA HMO |
$18.98
|
| Rate for Payer: Cigna of CA HMO |
$19.62
|
| Rate for Payer: Cigna of CA PPO |
$19.62
|
| Rate for Payer: Cigna of CA PPO |
$13.93
|
| Rate for Payer: Cigna of CA PPO |
$18.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$16.92
|
| Rate for Payer: Galaxy Health WC |
$23.05
|
| Rate for Payer: Galaxy Health WC |
$23.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.82
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$14.92
|
| Rate for Payer: Multiplan Commercial |
$21.02
|
| Rate for Payer: Networks By Design Commercial |
$13.56
|
| Rate for Payer: Networks By Design Commercial |
$9.95
|
| Rate for Payer: Networks By Design Commercial |
$14.02
|
| Rate for Payer: Prime Health Services Commercial |
$23.05
|
| Rate for Payer: Prime Health Services Commercial |
$23.83
|
| Rate for Payer: Prime Health Services Commercial |
$16.92
|
|
|
OXACILLIN 2 GRAM SOLUTION FOR INJECTION [5926]
|
Facility
OP
|
$28.03
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.94
|
| 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 Exchange |
$5.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.18
|
| Rate for Payer: BCBS Transplant Transplant |
$16.82
|
| Rate for Payer: BCBS Transplant Transplant |
$11.94
|
| Rate for Payer: BCBS Transplant Transplant |
$16.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Central Health Plan Commercial |
$21.70
|
| Rate for Payer: Central Health Plan Commercial |
$15.92
|
| Rate for Payer: Central Health Plan Commercial |
$22.42
|
| Rate for Payer: Cigna of CA HMO |
$19.62
|
| Rate for Payer: Cigna of CA HMO |
$13.93
|
| Rate for Payer: Cigna of CA HMO |
$18.98
|
| Rate for Payer: Cigna of CA PPO |
$18.98
|
| Rate for Payer: Cigna of CA PPO |
$19.62
|
| Rate for Payer: Cigna of CA PPO |
$13.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.21
|
| Rate for Payer: Galaxy Health WC |
$16.92
|
| Rate for Payer: Galaxy Health WC |
$23.83
|
| Rate for Payer: Galaxy Health WC |
$23.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Global Benefits Group Commercial |
$16.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.92
|
| Rate for Payer: IEHP medi-cal |
$0.94
|
| Rate for Payer: IEHP medi-cal |
$0.94
|
| Rate for Payer: IEHP medi-cal |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$21.02
|
| Rate for Payer: Multiplan Commercial |
$14.92
|
| Rate for Payer: Networks By Design Commercial |
$13.56
|
| Rate for Payer: Networks By Design Commercial |
$9.95
|
| Rate for Payer: Networks By Design Commercial |
$14.02
|
| Rate for Payer: Prime Health Services Commercial |
$23.05
|
| Rate for Payer: Prime Health Services Commercial |
$23.83
|
| Rate for Payer: Prime Health Services Commercial |
$16.92
|
| Rate for Payer: Riverside University Health MISP |
$7.96
|
| Rate for Payer: Riverside University Health MISP |
$11.21
|
| Rate for Payer: Riverside University Health MISP |
$10.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.56
|
| Rate for Payer: United Healthcare All Other HMO |
$13.56
|
| Rate for Payer: United Healthcare All Other HMO |
$9.95
|
| Rate for Payer: United Healthcare All Other HMO |
$14.02
|
| Rate for Payer: United Healthcare HMO Rider |
$14.02
|
| Rate for Payer: United Healthcare HMO Rider |
$13.56
|
| Rate for Payer: United Healthcare HMO Rider |
$9.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.05
|
| Rate for Payer: Vantage Medical Group Senior |
$23.83
|
| Rate for Payer: Vantage Medical Group Senior |
$23.05
|
| Rate for Payer: Vantage Medical Group Senior |
$16.92
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]
|
Facility
IP
|
$2.40
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
1755749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
1755749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$17.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.98
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: BCBS Transplant Transplant |
$1.19
|
| Rate for Payer: BCBS Transplant Transplant |
$1.44
|
| Rate for Payer: BCBS Transplant Transplant |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: Riverside University Health MISP |
$0.79
|
| Rate for Payer: Riverside University Health MISP |
$0.96
|
| Rate for Payer: Riverside University Health MISP |
$0.48
|
| Rate for Payer: Riverside University Health MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.68
|
|
|
OXALIPLATIN 100 MG INTRAVENOUS SOLUTION [23929]
|
Facility
IP
|
$636.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$572.40 |
| Rate for Payer: Blue Shield of California Commercial |
$477.00
|
| Rate for Payer: Blue Shield of California EPN |
$339.62
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Central Health Plan Commercial |
$508.80
|
| Rate for Payer: Cigna of CA HMO |
$445.20
|
| Rate for Payer: Cigna of CA PPO |
$445.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$572.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.20
|
| Rate for Payer: Multiplan Commercial |
$477.00
|
| Rate for Payer: Networks By Design Commercial |
$318.00
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
|
|
OXALIPLATIN 100 MG INTRAVENOUS SOLUTION [23929]
|
Facility
OP
|
$636.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$572.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$349.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$349.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.98
|
| Rate for Payer: BCBS Transplant Transplant |
$381.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Central Health Plan Commercial |
$508.80
|
| Rate for Payer: Cigna of CA HMO |
$445.20
|
| Rate for Payer: Cigna of CA PPO |
$445.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$540.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$572.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$477.00
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.20
|
| Rate for Payer: Multiplan Commercial |
$477.00
|
| Rate for Payer: Networks By Design Commercial |
$318.00
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
| Rate for Payer: Riverside University Health MISP |
$254.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.00
|
| Rate for Payer: United Healthcare All Other HMO |
$318.00
|
| Rate for Payer: United Healthcare HMO Rider |
$318.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$540.60
|
| Rate for Payer: Vantage Medical Group Senior |
$540.60
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]
|
Facility
IP
|
$3.60
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
NDG99610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Blue Shield of California Commercial |
$2.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| 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 |
$0.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
NDG99610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$17.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.98
|
| Rate for Payer: BCBS Transplant Transplant |
$1.08
|
| Rate for Payer: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Riverside University Health MISP |
$1.44
|
| Rate for Payer: Riverside University Health MISP |
$0.72
|
| Rate for Payer: Riverside University Health MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
OXALIPLATIN 50 MG INTRAVENOUS SOLUTION [23928]
|
Facility
IP
|
$318.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$286.20 |
| Rate for Payer: Blue Shield of California Commercial |
$238.50
|
| Rate for Payer: Blue Shield of California EPN |
$169.81
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Central Health Plan Commercial |
$254.40
|
| Rate for Payer: Cigna of CA HMO |
$222.60
|
| Rate for Payer: Cigna of CA PPO |
$222.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: Networks By Design Commercial |
$159.00
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
|
|
OXALIPLATIN 50 MG INTRAVENOUS SOLUTION [23928]
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$286.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$174.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$174.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.98
|
| Rate for Payer: BCBS Transplant Transplant |
$190.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Central Health Plan Commercial |
$254.40
|
| Rate for Payer: Cigna of CA HMO |
$222.60
|
| Rate for Payer: Cigna of CA PPO |
$222.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$238.50
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: Networks By Design Commercial |
$159.00
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
| Rate for Payer: Riverside University Health MISP |
$127.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.00
|
| Rate for Payer: United Healthcare All Other HMO |
$159.00
|
| Rate for Payer: United Healthcare HMO Rider |
$159.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.30
|
| Rate for Payer: Vantage Medical Group Senior |
$270.30
|
|
|
OXANDROLONE 10 MG TABLET [33826]
|
Facility
OP
|
$11.30
|
|
|
Service Code
|
NDC 0245-0272-06
|
| Hospital Charge Code |
1710982
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.68
|
| Rate for Payer: BCBS Transplant Transplant |
$6.78
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.53
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Central Health Plan Commercial |
$9.04
|
| Rate for Payer: Cigna of CA HMO |
$7.91
|
| Rate for Payer: Cigna of CA PPO |
$7.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.52
|
| Rate for Payer: Galaxy Health WC |
$9.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.48
|
| Rate for Payer: IEHP medi-cal |
$3.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$8.48
|
| Rate for Payer: Networks By Design Commercial |
$7.34
|
| Rate for Payer: Prime Health Services Commercial |
$9.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.78
|
| Rate for Payer: Riverside University Health MISP |
$4.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.60
|
| Rate for Payer: Vantage Medical Group Senior |
$9.60
|
|
