|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| 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: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| 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 Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.70
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
OP
|
$403.76
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$363.38 |
| Rate for Payer: Adventist Health Commercial |
$80.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$302.82
|
| Rate for Payer: Blue Shield of California Commercial |
$255.98
|
| Rate for Payer: Blue Shield of California EPN |
$161.10
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Central Health Plan Commercial |
$323.01
|
| Rate for Payer: Cigna of CA HMO |
$282.63
|
| Rate for Payer: Cigna of CA PPO |
$282.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.50
|
| Rate for Payer: EPIC Health Plan Senior |
$161.50
|
| Rate for Payer: Galaxy Health WC |
$343.20
|
| Rate for Payer: Global Benefits Group Commercial |
$242.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$282.63
|
| Rate for Payer: Multiplan Commercial |
$302.82
|
| Rate for Payer: Networks By Design Commercial |
$201.88
|
| Rate for Payer: Prime Health Services Commercial |
$343.20
|
| Rate for Payer: Riverside University Health System MISP |
$161.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.53
|
| Rate for Payer: United Healthcare All Other HMO |
$147.49
|
| Rate for Payer: United Healthcare HMO Rider |
$144.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.20
|
| Rate for Payer: Vantage Medical Group Senior |
$343.20
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
IP
|
$403.76
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$363.38 |
| Rate for Payer: Adventist Health Commercial |
$80.75
|
| Rate for Payer: Blue Shield of California Commercial |
$323.82
|
| Rate for Payer: Blue Shield of California EPN |
$203.50
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Central Health Plan Commercial |
$323.01
|
| Rate for Payer: Cigna of CA HMO |
$282.63
|
| Rate for Payer: Cigna of CA PPO |
$282.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.50
|
| Rate for Payer: EPIC Health Plan Senior |
$161.50
|
| Rate for Payer: Galaxy Health WC |
$343.20
|
| Rate for Payer: Global Benefits Group Commercial |
$242.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.75
|
| Rate for Payer: Multiplan Commercial |
$302.82
|
| Rate for Payer: Networks By Design Commercial |
$201.88
|
| Rate for Payer: Prime Health Services Commercial |
$343.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.53
|
| Rate for Payer: United Healthcare All Other HMO |
$147.49
|
| Rate for Payer: United Healthcare HMO Rider |
$144.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.23
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$41,238.53
|
|
|
Service Code
|
APR-DRG 2264
|
| Min. Negotiated Rate |
$26,045.39 |
| Max. Negotiated Rate |
$41,238.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,045.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31,037.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41,238.53
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$15,612.00
|
|
|
Service Code
|
APR-DRG 2262
|
| Min. Negotiated Rate |
$9,860.21 |
| Max. Negotiated Rate |
$15,612.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,860.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,750.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,612.00
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$12,669.26
|
|
|
Service Code
|
APR-DRG 2261
|
| Min. Negotiated Rate |
$8,001.64 |
| Max. Negotiated Rate |
$12,669.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,001.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,535.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,669.26
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$24,464.34
|
|
|
Service Code
|
APR-DRG 2263
|
| Min. Negotiated Rate |
$15,451.16 |
| Max. Negotiated Rate |
$24,464.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,451.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,412.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,464.34
|
|
|
ANAL AND STOMAL PROCEDURES WITH CC
|
Facility
|
IP
|
$34,446.31
|
|
|
Service Code
|
MSDRG 348
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$34,446.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,446.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,250.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,152.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,271.86
|
| Rate for Payer: EPIC Health Plan Senior |
$20,847.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,952.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,533.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,396.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18,952.64
|
| Rate for Payer: Prime Health Services Medicare |
$20,089.80
|
| 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
|
|
|
ANAL AND STOMAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$60,417.90
|
|
|
Service Code
|
MSDRG 347
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$60,417.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60,417.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39,027.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54,639.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$53,728.34
|
| Rate for Payer: EPIC Health Plan Senior |
$35,818.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,562.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45,587.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43,633.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32,562.63
|
| Rate for Payer: Prime Health Services Medicare |
$34,516.39
|
| 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
|
|
|
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,913.32
|
|
|
Service Code
|
MSDRG 349
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$22,913.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,913.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,801.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,722.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,299.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,199.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,908.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,072.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,298.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,908.97
|
| Rate for Payer: Prime Health Services Medicare |
$13,683.51
|
| 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
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$42.42 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
ANGINA PECTORIS
|
Facility
|
IP
|
$18,473.31
|
|
|
Service Code
|
MSDRG 311
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$18,473.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,473.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,933.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,706.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,460.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11,640.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,582.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,815.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,180.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,582.23
|
| Rate for Payer: Prime Health Services Medicare |
$11,217.16
|
| 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
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$9,184.71
|
|
|
Service Code
|
APR-DRG 1982
|
| Min. Negotiated Rate |
$5,800.87 |
| Max. Negotiated Rate |
$9,184.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,800.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,912.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,184.71
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$7,571.35
|
|
|
Service Code
|
APR-DRG 1981
|
| Min. Negotiated Rate |
$4,781.90 |
| Max. Negotiated Rate |
$7,571.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,781.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,698.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,571.35
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$11,889.76
|
|
|
Service Code
|
APR-DRG 1983
|
| Min. Negotiated Rate |
$7,509.32 |
| Max. Negotiated Rate |
$11,889.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,509.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,948.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,889.76
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$20,699.83
|
|
|
Service Code
|
APR-DRG 1984
|
| Min. Negotiated Rate |
$13,073.58 |
| Max. Negotiated Rate |
$20,699.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,073.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,579.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,699.83
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
|
IP
|
$2,278.80
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$2,050.92 |
| Rate for Payer: Adventist Health Commercial |
$455.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,827.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,148.52
|
| Rate for Payer: Cash Price |
$1,025.46
|
| Rate for Payer: Central Health Plan Commercial |
$1,823.04
|
| Rate for Payer: Cigna of CA HMO |
$1,595.16
|
| Rate for Payer: Cigna of CA PPO |
$1,595.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,595.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.52
|
| Rate for Payer: EPIC Health Plan Senior |
$911.52
|
| Rate for Payer: Galaxy Health WC |
$1,936.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,050.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,447.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,344.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.76
|
| Rate for Payer: Multiplan Commercial |
$1,709.10
|
| Rate for Payer: Networks By Design Commercial |
$1,139.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,936.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.23
|
| Rate for Payer: United Healthcare All Other HMO |
$832.45
|
| Rate for Payer: United Healthcare HMO Rider |
$814.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$746.31
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
|
OP
|
$2,278.80
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$2,050.92 |
| Rate for Payer: Adventist Health Commercial |
$455.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,383.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,936.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,253.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,709.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,103.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,325.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,444.76
|
| Rate for Payer: Blue Shield of California EPN |
$909.24
|
| Rate for Payer: Cash Price |
$1,025.46
|
| Rate for Payer: Central Health Plan Commercial |
$1,823.04
|
| Rate for Payer: Cigna of CA HMO |
$1,595.16
|
| Rate for Payer: Cigna of CA PPO |
$1,595.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,936.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,936.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,936.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,595.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.52
|
| Rate for Payer: EPIC Health Plan Senior |
$911.52
|
| Rate for Payer: Galaxy Health WC |
$1,936.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,050.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,447.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$827.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,344.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,595.16
|
| Rate for Payer: Multiplan Commercial |
$1,709.10
|
| Rate for Payer: Networks By Design Commercial |
$1,139.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,936.98
|
| Rate for Payer: Riverside University Health System MISP |
$911.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,367.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,367.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.23
|
| Rate for Payer: United Healthcare All Other HMO |
$832.45
|
| Rate for Payer: United Healthcare HMO Rider |
$814.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$746.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,936.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,936.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,936.98
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
IP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$206.16 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Blue Shield of California Commercial |
$183.71
|
| Rate for Payer: Blue Shield of California EPN |
$115.45
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Central Health Plan Commercial |
$183.26
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Senior |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.81
|
| Rate for Payer: Multiplan Commercial |
$171.80
|
| Rate for Payer: Networks By Design Commercial |
$114.53
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.97
|
| Rate for Payer: United Healthcare All Other HMO |
$83.68
|
| Rate for Payer: United Healthcare HMO Rider |
$81.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.02
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
OP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$206.16 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.29
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Central Health Plan Commercial |
$183.26
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$194.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Senior |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$160.35
|
| Rate for Payer: Multiplan Commercial |
$171.80
|
| Rate for Payer: Networks By Design Commercial |
$114.53
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
| Rate for Payer: Riverside University Health System MISP |
$91.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.97
|
| Rate for Payer: United Healthcare All Other HMO |
$83.68
|
| Rate for Payer: United Healthcare HMO Rider |
$81.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.71
|
| Rate for Payer: Vantage Medical Group Senior |
$194.71
|
|
|
ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOSTIC
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 45990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,569.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,551.91
|
| 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 |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$144.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,997.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,783.75
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Preferred Health Network WC |
$5,665.21
|
| Rate for Payer: Prime Health Services Medicare |
$3,784.16
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,926.96
|
| 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 |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$8,028.56
|
|
|
Service Code
|
APR-DRG 0591
|
| Min. Negotiated Rate |
$5,070.67 |
| Max. Negotiated Rate |
$8,028.56 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,070.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,042.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,028.56
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$20,403.74
|
|
|
Service Code
|
APR-DRG 0593
|
| Min. Negotiated Rate |
$12,886.57 |
| Max. Negotiated Rate |
$20,403.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,886.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,356.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,403.74
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$31,467.69
|
|
|
Service Code
|
APR-DRG 0594
|
| Min. Negotiated Rate |
$19,874.33 |
| Max. Negotiated Rate |
$31,467.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,874.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,683.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,467.69
|
|
