|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 4280654930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Riverside University Health System MISP |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
DYSEQUILIBRIUM
|
Facility
|
IP
|
$19,781.36
|
|
|
Service Code
|
MSDRG 149
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$19,781.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,781.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,777.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,889.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,591.69
|
| Rate for Payer: EPIC Health Plan Senior |
$12,394.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,267.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,774.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,098.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,267.69
|
| Rate for Payer: Prime Health Services Medicare |
$11,943.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC
|
Facility
|
IP
|
$33,464.61
|
|
|
Service Code
|
MSDRG 147
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$33,464.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,464.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21,616.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,264.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,423.01
|
| Rate for Payer: EPIC Health Plan Senior |
$20,282.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,438.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25,813.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24,707.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18,438.19
|
| Rate for Payer: Prime Health Services Medicare |
$19,544.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$55,727.85
|
|
|
Service Code
|
MSDRG 146
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$55,727.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,727.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35,997.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50,398.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,673.05
|
| Rate for Payer: EPIC Health Plan Senior |
$33,115.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,104.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,146.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40,340.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30,104.88
|
| Rate for Payer: Prime Health Services Medicare |
$31,911.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$20,978.87
|
|
|
Service Code
|
MSDRG 148
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$20,978.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,978.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,972.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,627.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13,084.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,895.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,653.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,939.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,895.26
|
| Rate for Payer: Prime Health Services Medicare |
$12,608.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$12,183.83
|
|
|
Service Code
|
APR-DRG 1101
|
| Min. Negotiated Rate |
$7,695.05 |
| Max. Negotiated Rate |
$12,183.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,695.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,169.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,183.83
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$19,537.64
|
|
|
Service Code
|
APR-DRG 1103
|
| Min. Negotiated Rate |
$12,339.56 |
| Max. Negotiated Rate |
$19,537.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,339.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,704.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,537.64
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$33,226.08
|
|
|
Service Code
|
APR-DRG 1104
|
| Min. Negotiated Rate |
$20,984.89 |
| Max. Negotiated Rate |
$33,226.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,984.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,007.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,226.08
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$13,178.84
|
|
|
Service Code
|
APR-DRG 1102
|
| Min. Negotiated Rate |
$8,323.48 |
| Max. Negotiated Rate |
$13,178.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,323.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,918.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,178.84
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$11,730.64
|
|
|
Service Code
|
APR-DRG 7591
|
| Min. Negotiated Rate |
$7,408.82 |
| Max. Negotiated Rate |
$11,730.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,408.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,828.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,730.64
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$24,788.63
|
|
|
Service Code
|
APR-DRG 7593
|
| Min. Negotiated Rate |
$15,655.98 |
| Max. Negotiated Rate |
$24,788.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,655.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,656.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,788.63
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$15,972.52
|
|
|
Service Code
|
APR-DRG 7592
|
| Min. Negotiated Rate |
$10,087.91 |
| Max. Negotiated Rate |
$15,972.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,087.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,021.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,972.52
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$45,508.61
|
|
|
Service Code
|
APR-DRG 7594
|
| Min. Negotiated Rate |
$28,742.28 |
| Max. Negotiated Rate |
$45,508.61 |
| Rate for Payer: Adventist Health Medi-Cal |
$28,742.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34,251.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45,508.61
|
|
|
ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$558,626.04
|
|
|
Service Code
|
MSDRG 003
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$558,626.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$558,626.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$360,849.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$505,202.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$484,506.92
|
| Rate for Payer: EPIC Health Plan Senior |
$323,004.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$293,640.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411,096.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$393,478.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$293,640.56
|
| Rate for Payer: Prime Health Services Medicare |
$311,258.99
|
| 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
|
|
|
ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 5167213031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Riverside University Health System MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 5167213031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION [81696]
|
Facility
|
OP
|
$260.92
|
|
|
Service Code
|
HCPCS J1299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$277.70 |
| Rate for Payer: Adventist Health Commercial |
$52.18
|
| Rate for Payer: Adventist Health Medi-Cal |
$44.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$277.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.41
|
| Rate for Payer: Blue Shield of California Commercial |
$165.42
|
| Rate for Payer: Blue Shield of California EPN |
$104.11
|
| Rate for Payer: Cash Price |
$117.41
|
| Rate for Payer: Cash Price |
$117.41
|
| Rate for Payer: Central Health Plan Commercial |
$208.74
|
| Rate for Payer: Cigna of CA HMO |
$182.64
|
| Rate for Payer: Cigna of CA PPO |
$182.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.93
|
| Rate for Payer: EPIC Health Plan Senior |
$48.62
|
| Rate for Payer: Galaxy Health WC |
$221.78
|
| Rate for Payer: Global Benefits Group Commercial |
$156.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$72.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$59.23
|
| Rate for Payer: Multiplan Commercial |
$195.69
|
| Rate for Payer: Networks By Design Commercial |
$130.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$221.78
|
| Rate for Payer: Prime Health Services Medicare |
$46.85
|
| Rate for Payer: Riverside University Health System MISP |
$48.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Other HMO |
$95.31
|
| Rate for Payer: United Healthcare HMO Rider |
$93.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$44.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.62
|
| Rate for Payer: Vantage Medical Group Senior |
$48.62
|
|
|
ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION [81696]
|
Facility
|
IP
|
$260.92
|
|
|
Service Code
|
HCPCS J1299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.18 |
| Max. Negotiated Rate |
$234.83 |
| Rate for Payer: Adventist Health Commercial |
$52.18
|
| Rate for Payer: Blue Shield of California Commercial |
$209.26
|
| Rate for Payer: Blue Shield of California EPN |
$131.50
|
| Rate for Payer: Cash Price |
$117.41
|
| Rate for Payer: Central Health Plan Commercial |
$208.74
|
| Rate for Payer: Cigna of CA HMO |
$182.64
|
| Rate for Payer: Cigna of CA PPO |
$182.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.37
|
| Rate for Payer: EPIC Health Plan Senior |
$104.37
|
| Rate for Payer: Galaxy Health WC |
$221.78
|
| Rate for Payer: Global Benefits Group Commercial |
$156.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.18
|
| Rate for Payer: Multiplan Commercial |
$195.69
|
| Rate for Payer: Networks By Design Commercial |
$130.46
|
| Rate for Payer: Prime Health Services Commercial |
$221.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Other HMO |
$95.31
|
| Rate for Payer: United Healthcare HMO Rider |
$93.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.45
|
|
|
EDETATE DISODIUM 3 % EYE DROPS [222529]
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.06
|
| Rate for Payer: Blue Shield of California EPN |
$15.12
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Other HMO |
$10.96
|
| Rate for Payer: United Healthcare HMO Rider |
$10.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
|
|
EDETATE DISODIUM 3 % EYE DROPS [222529]
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19.02
|
| Rate for Payer: Blue Shield of California EPN |
$11.97
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Other HMO |
$10.96
|
| Rate for Payer: United Healthcare HMO Rider |
$10.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
EFAVIRENZ 600 MG TABLET [32298]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 3172250430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.03
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
EFAVIRENZ 600 MG TABLET [32298]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 3172250430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
EFLAPEGRASTIM-XNST 13.2 MG/0.6 ML SUBCUTANEOUS SYRINGE [235968]
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
HCPCS J1449
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$8,100.00 |
| Rate for Payer: Adventist Health Commercial |
$1,800.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,218.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,536.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,200.00
|
| Rate for Payer: Cigna of CA HMO |
$6,300.00
|
| Rate for Payer: Cigna of CA PPO |
$6,300.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,600.00
|
| Rate for Payer: Galaxy Health WC |
$7,650.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,100.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,715.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,310.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.00
|
| Rate for Payer: Multiplan Commercial |
$6,750.00
|
| Rate for Payer: Networks By Design Commercial |
$4,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,650.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,377.70
|
| Rate for Payer: United Healthcare All Other HMO |
$3,287.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3,216.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,947.50
|
|
|
EFLAPEGRASTIM-XNST 13.2 MG/0.6 ML SUBCUTANEOUS SYRINGE [235968]
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
HCPCS J1449
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$8,100.00 |
| Rate for Payer: Adventist Health Commercial |
$1,800.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.20
|
| Rate for Payer: Blue Shield of California Commercial |
$45.00
|
| Rate for Payer: Blue Shield of California EPN |
$40.91
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,200.00
|
| Rate for Payer: Cigna of CA HMO |
$6,300.00
|
| Rate for Payer: Cigna of CA PPO |
$6,300.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.62
|
| Rate for Payer: EPIC Health Plan Senior |
$42.42
|
| Rate for Payer: Galaxy Health WC |
$7,650.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,100.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,715.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$6,750.00
|
| Rate for Payer: Networks By Design Commercial |
$4,500.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.56
|
| Rate for Payer: Prime Health Services Commercial |
$7,650.00
|
| Rate for Payer: Prime Health Services Medicare |
$40.87
|
| Rate for Payer: Riverside University Health System MISP |
$42.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,400.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,377.70
|
| Rate for Payer: United Healthcare All Other HMO |
$3,287.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3,216.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,947.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.42
|
| Rate for Payer: Vantage Medical Group Senior |
$42.42
|
|
|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$23,380.72
|
|
|
Service Code
|
APR-DRG 3241
|
| Min. Negotiated Rate |
$14,766.77 |
| Max. Negotiated Rate |
$23,380.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,766.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,597.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,380.72
|
|
