|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Central Health Plan Commercial |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Riverside University Health System MISP |
$1.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.87
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Central Health Plan Commercial |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
|
IP
|
$87.37
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$78.63 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Blue Shield of California Commercial |
$70.07
|
| Rate for Payer: Blue Shield of California EPN |
$44.03
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Central Health Plan Commercial |
$69.90
|
| Rate for Payer: Cigna of CA HMO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$61.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.95
|
| Rate for Payer: EPIC Health Plan Senior |
$34.95
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.47
|
| Rate for Payer: Multiplan Commercial |
$65.53
|
| Rate for Payer: Networks By Design Commercial |
$43.69
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.79
|
| Rate for Payer: United Healthcare All Other HMO |
$31.92
|
| Rate for Payer: United Healthcare HMO Rider |
$31.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.61
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
|
OP
|
$87.37
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$78.63 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Central Health Plan Commercial |
$69.90
|
| Rate for Payer: Cigna of CA HMO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$61.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.95
|
| Rate for Payer: EPIC Health Plan Senior |
$34.95
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.16
|
| Rate for Payer: Multiplan Commercial |
$65.53
|
| Rate for Payer: Networks By Design Commercial |
$43.69
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
| Rate for Payer: Riverside University Health System MISP |
$34.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.79
|
| Rate for Payer: United Healthcare All Other HMO |
$31.92
|
| Rate for Payer: United Healthcare HMO Rider |
$31.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.26
|
| Rate for Payer: Vantage Medical Group Senior |
$74.26
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
OP
|
$6.60
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$16.81 |
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Central Health Plan Commercial |
$13.98
|
| Rate for Payer: Central Health Plan Commercial |
$5.09
|
| Rate for Payer: Central Health Plan Commercial |
$5.14
|
| Rate for Payer: Central Health Plan Commercial |
$5.28
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA HMO |
$12.23
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$4.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.57
|
| Rate for Payer: EPIC Health Plan Senior |
$2.64
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$3.86
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$8.73
|
| Rate for Payer: Prime Health Services Commercial |
$5.47
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Riverside University Health System MISP |
$2.54
|
| Rate for Payer: Riverside University Health System MISP |
$2.57
|
| Rate for Payer: Riverside University Health System MISP |
$6.99
|
| Rate for Payer: Riverside University Health System MISP |
$2.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO |
$2.41
|
| Rate for Payer: United Healthcare All Other HMO |
$6.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.35
|
| Rate for Payer: United Healthcare HMO Rider |
$2.30
|
| Rate for Payer: United Healthcare HMO Rider |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$5.47
|
| Rate for Payer: Vantage Medical Group Senior |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.61
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Blue Shield of California Commercial |
$5.10
|
| Rate for Payer: Blue Shield of California Commercial |
$14.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5.16
|
| Rate for Payer: Blue Shield of California EPN |
$3.21
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Blue Shield of California EPN |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$3.33
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Central Health Plan Commercial |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$5.09
|
| Rate for Payer: Central Health Plan Commercial |
$13.98
|
| Rate for Payer: Central Health Plan Commercial |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA HMO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$4.50
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Senior |
$2.57
|
| Rate for Payer: EPIC Health Plan Senior |
$2.64
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$3.86
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Prime Health Services Commercial |
$5.47
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO |
$6.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.41
|
| Rate for Payer: United Healthcare All Other HMO |
$2.35
|
| Rate for Payer: United Healthcare HMO Rider |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2.36
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.11
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH DIRECT CLOSURE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 26951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,165.61 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH LOCAL ADVANCEMENT FLAPS (V-Y, HOOD)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 26952
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$534.70 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$534.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$590.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
AMPUTATION, FOOT; TRANSMETATARSAL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 28805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$725.53 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$725.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC
|
Facility
|
IP
|
$75,022.31
|
|
|
Service Code
|
MSDRG 240
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$75,022.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75,022.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48,461.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67,847.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,356.14
|
| Rate for Payer: EPIC Health Plan Senior |
$44,237.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,215.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56,302.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53,889.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$40,215.84
|
| Rate for Payer: Prime Health Services Medicare |
$42,628.79
|
| 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
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
|
IP
|
$129,534.22
|
|
|
Service Code
|
MSDRG 239
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$129,534.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$129,534.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83,673.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117,146.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$113,490.18
|
| Rate for Payer: EPIC Health Plan Senior |
$75,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,781.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96,294.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$92,167.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$68,781.93
|
| Rate for Payer: Prime Health Services Medicare |
$72,908.85
|
| 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
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
|
IP
|
$36,436.02
|
|
|
Service Code
|
MSDRG 241
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$36,436.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,436.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,536.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32,951.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,992.26
|
| Rate for Payer: EPIC Health Plan Senior |
$21,994.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,995.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,993.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,793.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19,995.31
|
| Rate for Payer: Prime Health Services Medicare |
$21,195.03
|
| 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
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$59,894.15
|
|
|
Service Code
|
MSDRG 475
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$59,894.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59,894.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38,689.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54,166.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$53,275.46
|
| Rate for Payer: EPIC Health Plan Senior |
$35,516.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,288.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45,203.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43,266.13
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32,288.16
|
| Rate for Payer: Prime Health Services Medicare |
$34,225.45
|
| 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
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$112,984.84
|
|
|
Service Code
|
MSDRG 474
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$112,984.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112,984.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72,983.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102,179.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$99,180.64
|
| Rate for Payer: EPIC Health Plan Senior |
$66,120.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,109.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,153.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80,546.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60,109.48
|
| Rate for Payer: Prime Health Services Medicare |
$63,716.05
|
| 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
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$31,061.68
|
|
|
Service Code
|
MSDRG 476
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$31,061.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,061.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,064.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,091.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,345.32
|
| Rate for Payer: EPIC Health Plan Senior |
$18,896.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,178.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,050.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,019.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,178.98
|
| Rate for Payer: Prime Health Services Medicare |
$18,209.72
|
| 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
|
|
|
AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAY AMPUTATION), SINGLE, WITH OR WITHOUT INTEROSSEOUS TRANSFER
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 26910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$584.65 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$584.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$645.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$17,873.93
|
|
|
Service Code
|
APR-DRG 3051
|
| Min. Negotiated Rate |
$11,288.80 |
| Max. Negotiated Rate |
$17,873.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,288.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,452.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,873.93
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$59,317.90
|
|
|
Service Code
|
APR-DRG 3054
|
| Min. Negotiated Rate |
$37,463.94 |
| Max. Negotiated Rate |
$59,317.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$37,463.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44,644.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59,317.90
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$23,904.41
|
|
|
Service Code
|
APR-DRG 3052
|
| Min. Negotiated Rate |
$15,097.52 |
| Max. Negotiated Rate |
$23,904.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,097.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,991.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,904.41
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$35,151.65
|
|
|
Service Code
|
APR-DRG 3053
|
| Min. Negotiated Rate |
$22,201.04 |
| Max. Negotiated Rate |
$35,151.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,201.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,456.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35,151.65
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$49,224.43
|
|
|
Service Code
|
MSDRG 617
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$49,224.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,224.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31,796.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44,516.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,049.80
|
| Rate for Payer: EPIC Health Plan Senior |
$29,366.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,696.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37,375.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,773.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26,696.85
|
| Rate for Payer: Prime Health Services Medicare |
$28,298.66
|
| 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
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$91,784.88
|
|
|
Service Code
|
MSDRG 616
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$91,784.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$91,784.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59,289.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83,007.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$80,849.97
|
| Rate for Payer: EPIC Health Plan Senior |
$53,899.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48,999.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68,599.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65,659.97
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48,999.98
|
| Rate for Payer: Prime Health Services Medicare |
$51,939.98
|
| 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
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$37,328.24
|
|
|
Service Code
|
MSDRG 618
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$37,328.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,328.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,112.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,758.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,763.72
|
| Rate for Payer: EPIC Health Plan Senior |
$22,509.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,462.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,648.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,420.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,462.86
|
| Rate for Payer: Prime Health Services Medicare |
$21,690.63
|
| 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
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$392.54 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$392.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$433.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 1366845301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
