|
SIMPLE SYRUP [7242]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 3877917791
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
SIMPLE SYRUP [7242]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0395266116
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
|
IP
|
$192,500.00
|
|
|
Service Code
|
MSDRG 008
|
| Min. Negotiated Rate |
$78,200.51 |
| Max. Negotiated Rate |
$192,500.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$147,507.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171,250.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95,283.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133,400.69
|
| Rate for Payer: Blue Shield of California Transplant |
$102,000.00
|
| Rate for Payer: CareMore Health Medicare Advantage |
$78,200.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$129,030.84
|
| Rate for Payer: EPIC Health Plan Senior |
$86,020.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$90,300.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$96,050.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$78,200.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109,480.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104,788.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$160,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$78,200.51
|
| Rate for Payer: Prime Health Services Medicare |
$82,892.54
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS
|
Facility
|
IP
|
$192,500.00
|
|
|
Service Code
|
MSDRG 019
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$192,500.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$171,250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174,421.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112,669.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157,740.61
|
| Rate for Payer: Blue Shield of California Transplant |
$102,000.00
|
| Rate for Payer: CareMore Health Medicare Advantage |
$99,302.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$163,848.86
|
| Rate for Payer: EPIC Health Plan Senior |
$109,232.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$90,300.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$96,050.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$99,302.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139,023.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$133,065.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$160,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$99,302.34
|
| Rate for Payer: Prime Health Services Medicare |
$105,260.48
|
| 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
|
|
|
SIMVASTATIN 20 MG TABLET [11365]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 6808451201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
|
SIMVASTATIN 20 MG TABLET [11365]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 6808451201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION [11368]
|
Facility
|
IP
|
$156.56
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$140.90 |
| Rate for Payer: Adventist Health Commercial |
$31.31
|
| Rate for Payer: Blue Shield of California Commercial |
$125.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.91
|
| Rate for Payer: Cash Price |
$70.45
|
| Rate for Payer: Central Health Plan Commercial |
$125.25
|
| Rate for Payer: Cigna of CA HMO |
$109.59
|
| Rate for Payer: Cigna of CA PPO |
$109.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.62
|
| Rate for Payer: EPIC Health Plan Senior |
$62.62
|
| Rate for Payer: Galaxy Health WC |
$133.08
|
| Rate for Payer: Global Benefits Group Commercial |
$93.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.31
|
| Rate for Payer: Multiplan Commercial |
$117.42
|
| Rate for Payer: Networks By Design Commercial |
$78.28
|
| Rate for Payer: Prime Health Services Commercial |
$133.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.76
|
| Rate for Payer: United Healthcare All Other HMO |
$57.19
|
| Rate for Payer: United Healthcare HMO Rider |
$55.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.27
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION [11368]
|
Facility
|
OP
|
$156.56
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$887.77 |
| Rate for Payer: Adventist Health Commercial |
$31.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$887.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.86
|
| Rate for Payer: Blue Shield of California Commercial |
$163.86
|
| Rate for Payer: Blue Shield of California EPN |
$148.96
|
| Rate for Payer: Cash Price |
$70.45
|
| Rate for Payer: Cash Price |
$70.45
|
| Rate for Payer: Central Health Plan Commercial |
$125.25
|
| Rate for Payer: Cigna of CA HMO |
$109.59
|
| Rate for Payer: Cigna of CA PPO |
$109.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.62
|
| Rate for Payer: EPIC Health Plan Senior |
$62.62
|
| Rate for Payer: Galaxy Health WC |
$133.08
|
| Rate for Payer: Global Benefits Group Commercial |
$93.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.59
|
| Rate for Payer: Multiplan Commercial |
$117.42
|
| Rate for Payer: Networks By Design Commercial |
$78.28
|
| Rate for Payer: Prime Health Services Commercial |
$133.08
|
| Rate for Payer: Riverside University Health System MISP |
$62.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.76
|
| Rate for Payer: United Healthcare All Other HMO |
$57.19
|
| Rate for Payer: United Healthcare HMO Rider |
$55.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.08
|
| Rate for Payer: Vantage Medical Group Senior |
$133.08
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$105,815.54
|
|
|
Service Code
|
MSDRG 402
|
| Min. Negotiated Rate |
$56,352.53 |
| Max. Negotiated Rate |
$105,815.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105,815.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68,352.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95,695.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$92,981.67
|
| Rate for Payer: EPIC Health Plan Senior |
$61,987.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,352.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78,893.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75,512.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$56,352.53
|
| Rate for Payer: Prime Health Services Medicare |
$59,733.68
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$50,989.22
|
|
|
Service Code
|
APR-DRG 3002
|
| Min. Negotiated Rate |
$32,203.72 |
| Max. Negotiated Rate |
$50,989.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$32,203.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38,376.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50,989.22
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$65,751.21
|
|
|
Service Code
|
APR-DRG 3003
|
| Min. Negotiated Rate |
$41,527.08 |
| Max. Negotiated Rate |
$65,751.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$41,527.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49,486.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65,751.21
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$46,558.00
|
|
|
Service Code
|
APR-DRG 3001
|
| Min. Negotiated Rate |
$29,405.05 |
| Max. Negotiated Rate |
$46,558.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$29,405.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35,041.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46,558.00
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$96,246.06
|
|
|
Service Code
|
APR-DRG 3004
|
| Min. Negotiated Rate |
$60,786.98 |
| Max. Negotiated Rate |
$96,246.06 |
| Rate for Payer: Adventist Health Medi-Cal |
$60,786.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72,437.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96,246.06
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$140,269.74
|
|
|
Service Code
|
MSDRG 450
|
| Min. Negotiated Rate |
$74,407.70 |
| Max. Negotiated Rate |
$140,269.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$140,269.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90,608.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126,855.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$122,772.71
|
| Rate for Payer: EPIC Health Plan Senior |
$81,848.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74,407.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104,170.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$99,706.32
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$74,407.70
|
| Rate for Payer: Prime Health Services Medicare |
$78,872.16
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$85,020.90
|
|
|
Service Code
|
MSDRG 451
|
| Min. Negotiated Rate |
$45,455.44 |
| Max. Negotiated Rate |
$85,020.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85,020.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54,920.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76,889.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$75,001.48
|
| Rate for Payer: EPIC Health Plan Senior |
$50,000.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$45,455.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63,637.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60,910.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$45,455.44
|
| Rate for Payer: Prime Health Services Medicare |
$48,182.77
|
|
|
SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$55,669.95
|
|
|
Service Code
|
MSDRG 135
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$55,669.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,669.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35,960.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50,345.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,870.06
|
| Rate for Payer: EPIC Health Plan Senior |
$33,913.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,830.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43,162.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41,312.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30,830.34
|
| Rate for Payer: Prime Health Services Medicare |
$32,680.16
|
| 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
|
|
|
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,721.68
|
|
|
Service Code
|
MSDRG 136
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$26,721.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,721.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,261.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,166.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,592.69
|
| Rate for Payer: EPIC Health Plan Senior |
$16,395.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,904.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,866.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,972.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,904.66
|
| Rate for Payer: Prime Health Services Medicare |
$15,798.94
|
| 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
|
|
|
SIPULEUCEL-T IN LACTATED RINGERS 50 MILLION CELL/250 ML IV SUSPENSION [104852]
|
Facility
|
IP
|
$300.49
|
|
|
Service Code
|
HCPCS Q2043
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$270.44 |
| Rate for Payer: Adventist Health Commercial |
$60.10
|
| Rate for Payer: Blue Shield of California Commercial |
$240.99
|
| Rate for Payer: Blue Shield of California EPN |
$151.45
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Central Health Plan Commercial |
$240.39
|
| Rate for Payer: Cigna of CA HMO |
$210.34
|
| Rate for Payer: Cigna of CA PPO |
$210.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.20
|
| Rate for Payer: EPIC Health Plan Senior |
$120.20
|
| Rate for Payer: Galaxy Health WC |
$255.42
|
| Rate for Payer: Global Benefits Group Commercial |
$180.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.10
|
| Rate for Payer: Multiplan Commercial |
$225.37
|
| Rate for Payer: Networks By Design Commercial |
$150.25
|
| Rate for Payer: Prime Health Services Commercial |
$255.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.77
|
| Rate for Payer: United Healthcare All Other HMO |
$109.77
|
| Rate for Payer: United Healthcare HMO Rider |
$107.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.41
|
|
|
SIPULEUCEL-T IN LACTATED RINGERS 50 MILLION CELL/250 ML IV SUSPENSION [104852]
|
Facility
|
OP
|
$300.49
|
|
|
Service Code
|
HCPCS Q2043
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$353,338.21 |
| Rate for Payer: Adventist Health Commercial |
$60.10
|
| Rate for Payer: Adventist Health Medi-Cal |
$55,932.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$353,338.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83,898.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61,525.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55,932.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61,352.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76,562.11
|
| Rate for Payer: Blue Shield of California Commercial |
$85,602.00
|
| Rate for Payer: Blue Shield of California EPN |
$77,820.00
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Central Health Plan Commercial |
$240.39
|
| Rate for Payer: Cigna of CA HMO |
$210.34
|
| Rate for Payer: Cigna of CA PPO |
$210.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69,915.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$61,525.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61,525.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$92,288.51
|
| Rate for Payer: EPIC Health Plan Senior |
$61,525.67
|
| Rate for Payer: Galaxy Health WC |
$255.42
|
| Rate for Payer: Global Benefits Group Commercial |
$180.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$91,729.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55,932.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,932.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103,367.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78,305.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74,949.46
|
| Rate for Payer: Multiplan Commercial |
$225.37
|
| Rate for Payer: Networks By Design Commercial |
$150.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$55,932.43
|
| Rate for Payer: Prime Health Services Commercial |
$255.42
|
| Rate for Payer: Prime Health Services Medicare |
$59,288.38
|
| Rate for Payer: Riverside University Health System MISP |
$61,525.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.77
|
| Rate for Payer: United Healthcare All Other HMO |
$109.77
|
| Rate for Payer: United Healthcare HMO Rider |
$107.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$55,932.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69,915.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61,525.67
|
| Rate for Payer: Vantage Medical Group Senior |
$61,525.67
|
|
|
SIROLIMUS 0.5 MG TABLET [104764]
|
Facility
|
IP
|
$5.23
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.71 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4.19
|
| Rate for Payer: Blue Shield of California Commercial |
$8.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3.85
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Blue Shield of California EPN |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Central Health Plan Commercial |
$5.24
|
| Rate for Payer: Central Health Plan Commercial |
$1.39
|
| Rate for Payer: Central Health Plan Commercial |
$8.28
|
| Rate for Payer: Central Health Plan Commercial |
$3.84
|
| Rate for Payer: Central Health Plan Commercial |
$4.18
|
| Rate for Payer: Cigna of CA HMO |
$4.58
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$7.25
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$3.66
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$7.25
|
| Rate for Payer: Cigna of CA PPO |
$4.58
|
| Rate for Payer: Cigna of CA PPO |
$3.66
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2.62
|
| Rate for Payer: EPIC Health Plan Senior |
$2.09
|
| Rate for Payer: Galaxy Health WC |
$4.45
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$3.93
|
| Rate for Payer: Global Benefits Group Commercial |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Networks By Design Commercial |
$3.27
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$5.57
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
| Rate for Payer: Prime Health Services Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$3.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2.34
|
| Rate for Payer: United Healthcare HMO Rider |
$3.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
|
|
SIROLIMUS 0.5 MG TABLET [104764]
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$43.33 |
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California EPN |
$11.77
|
| Rate for Payer: Blue Shield of California EPN |
$11.77
|
| Rate for Payer: Blue Shield of California EPN |
$11.77
|
| Rate for Payer: Blue Shield of California EPN |
$11.77
|
| Rate for Payer: Blue Shield of California EPN |
$11.77
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Central Health Plan Commercial |
$3.84
|
| Rate for Payer: Central Health Plan Commercial |
$8.28
|
| Rate for Payer: Central Health Plan Commercial |
$4.18
|
| Rate for Payer: Central Health Plan Commercial |
$1.39
|
| Rate for Payer: Central Health Plan Commercial |
$5.24
|
| Rate for Payer: Cigna of CA HMO |
$7.25
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$4.58
|
| Rate for Payer: Cigna of CA HMO |
$3.66
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$4.58
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$3.66
|
| Rate for Payer: Cigna of CA PPO |
$7.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Senior |
$2.62
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$4.45
|
| Rate for Payer: Galaxy Health WC |
$5.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$3.93
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.66
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
| Rate for Payer: Multiplan Commercial |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$3.27
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
| Rate for Payer: Prime Health Services Commercial |
$4.45
|
| Rate for Payer: Prime Health Services Commercial |
$5.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Riverside University Health System MISP |
$2.62
|
| Rate for Payer: Riverside University Health System MISP |
$1.92
|
| Rate for Payer: Riverside University Health System MISP |
$4.14
|
| Rate for Payer: Riverside University Health System MISP |
$2.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$3.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.87
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2.34
|
| Rate for Payer: United Healthcare HMO Rider |
$3.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$4.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
|
|
SIROLIMUS 1 MG/ML ORAL SOLUTION [26336]
|
Facility
|
OP
|
$12.04
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$43.33 |
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Adventist Health Commercial |
$4.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California EPN |
$11.77
|
| Rate for Payer: Blue Shield of California EPN |
$11.77
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Central Health Plan Commercial |
$16.84
|
| Rate for Payer: Central Health Plan Commercial |
$9.63
|
| Rate for Payer: Cigna of CA HMO |
$8.43
|
| Rate for Payer: Cigna of CA HMO |
$14.73
|
| Rate for Payer: Cigna of CA PPO |
$8.43
|
| Rate for Payer: Cigna of CA PPO |
$14.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.42
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$17.89
|
| Rate for Payer: Global Benefits Group Commercial |
$12.63
|
| Rate for Payer: Global Benefits Group Commercial |
$7.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.43
|
| Rate for Payer: Multiplan Commercial |
$15.79
|
| Rate for Payer: Multiplan Commercial |
$9.03
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Networks By Design Commercial |
$6.02
|
| Rate for Payer: Prime Health Services Commercial |
$17.89
|
| Rate for Payer: Prime Health Services Commercial |
$10.23
|
| Rate for Payer: Riverside University Health System MISP |
$4.82
|
| Rate for Payer: Riverside University Health System MISP |
$8.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.90
|
| Rate for Payer: United Healthcare All Other HMO |
$7.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4.40
|
| Rate for Payer: United Healthcare HMO Rider |
$7.52
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Vantage Medical Group Senior |
$17.89
|
| Rate for Payer: Vantage Medical Group Senior |
$10.23
|
|
|
SIROLIMUS 1 MG/ML ORAL SOLUTION [26336]
|
Facility
|
IP
|
$21.05
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Adventist Health Commercial |
$4.21
|
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$16.88
|
| Rate for Payer: Blue Shield of California Commercial |
$9.66
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$10.61
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Central Health Plan Commercial |
$16.84
|
| Rate for Payer: Central Health Plan Commercial |
$9.63
|
| Rate for Payer: Cigna of CA HMO |
$8.43
|
| Rate for Payer: Cigna of CA HMO |
$14.73
|
| Rate for Payer: Cigna of CA PPO |
$8.43
|
| Rate for Payer: Cigna of CA PPO |
$14.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.42
|
| Rate for Payer: Galaxy Health WC |
$17.89
|
| Rate for Payer: Galaxy Health WC |
$10.23
|
| Rate for Payer: Global Benefits Group Commercial |
$7.22
|
| Rate for Payer: Global Benefits Group Commercial |
$12.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$9.03
|
| Rate for Payer: Multiplan Commercial |
$15.79
|
| Rate for Payer: Networks By Design Commercial |
$6.02
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.89
|
| Rate for Payer: Prime Health Services Commercial |
$10.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.90
|
| Rate for Payer: United Healthcare All Other HMO |
$7.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4.40
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$7.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.89
|
|
|
SIROLIMUS 1 MG TABLET [28958]
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California Commercial |
$4.33
|
| Rate for Payer: Blue Shield of California Commercial |
$13.36
|
| Rate for Payer: Blue Shield of California EPN |
$8.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$13.33
|
| Rate for Payer: Cigna of CA HMO |
$11.66
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$11.66
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$6.66
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$14.16
|
| Rate for Payer: Global Benefits Group Commercial |
$10.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$12.49
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$14.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$6.09
|
| Rate for Payer: United Healthcare HMO Rider |
$5.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
|
|
SIROLIMUS 1 MG TABLET [28958]
|
Facility
|
OP
|
$16.66
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$43.33 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California EPN |
$11.77
|
| Rate for Payer: Blue Shield of California EPN |
$11.77
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$13.33
|
| Rate for Payer: Cigna of CA HMO |
$11.66
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$11.66
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.66
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$6.66
|
| Rate for Payer: Galaxy Health WC |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$10.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.66
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$12.49
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$14.16
|
| Rate for Payer: Riverside University Health System MISP |
$6.66
|
| Rate for Payer: Riverside University Health System MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$6.09
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$5.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$14.16
|
|
