|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$58,095.73
|
|
|
Service Code
|
MSDRG 166
|
| Min. Negotiated Rate |
$43,355.02 |
| Max. Negotiated Rate |
$58,095.73 |
| Rate for Payer: EPIC Health Plan Medicare |
$43,355.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43,355.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49,858.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$58,095.73
|
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,683.32
|
|
|
Service Code
|
MSDRG 168
|
| Min. Negotiated Rate |
$16,181.58 |
| Max. Negotiated Rate |
$21,683.32 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,181.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,181.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,608.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,683.32
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC
|
Facility
|
IP
|
$27,235.83
|
|
|
Service Code
|
MSDRG 580
|
| Min. Negotiated Rate |
$20,325.25 |
| Max. Negotiated Rate |
$27,235.83 |
| Rate for Payer: EPIC Health Plan Medicare |
$20,325.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,325.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,374.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,235.83
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC
|
Facility
|
IP
|
$50,430.27
|
|
|
Service Code
|
MSDRG 579
|
| Min. Negotiated Rate |
$37,634.53 |
| Max. Negotiated Rate |
$50,430.27 |
| Rate for Payer: EPIC Health Plan Medicare |
$37,634.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,634.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43,279.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50,430.27
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,861.06
|
|
|
Service Code
|
MSDRG 581
|
| Min. Negotiated Rate |
$17,060.49 |
| Max. Negotiated Rate |
$22,861.06 |
| Rate for Payer: EPIC Health Plan Medicare |
$17,060.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,060.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,619.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,861.06
|
|
|
OTHER VASCULAR PROCEDURES WITH CC
|
Facility
|
IP
|
$40,558.26
|
|
|
Service Code
|
MSDRG 253
|
| Min. Negotiated Rate |
$30,267.36 |
| Max. Negotiated Rate |
$40,558.26 |
| Rate for Payer: EPIC Health Plan Medicare |
$30,267.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,267.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,807.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40,558.26
|
|
|
OTHER VASCULAR PROCEDURES WITH MCC
|
Facility
|
IP
|
$54,266.06
|
|
|
Service Code
|
MSDRG 252
|
| Min. Negotiated Rate |
$40,497.06 |
| Max. Negotiated Rate |
$54,266.06 |
| Rate for Payer: EPIC Health Plan Medicare |
$40,497.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,497.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,571.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,266.06
|
|
|
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$28,060.44
|
|
|
Service Code
|
MSDRG 254
|
| Min. Negotiated Rate |
$20,940.63 |
| Max. Negotiated Rate |
$28,060.44 |
| Rate for Payer: EPIC Health Plan Medicare |
$20,940.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,940.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,081.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,060.44
|
|
|
OTITIS MEDIA AND URI WITH MCC
|
Facility
|
IP
|
$18,854.83
|
|
|
Service Code
|
MSDRG 152
|
| Min. Negotiated Rate |
$14,070.77 |
| Max. Negotiated Rate |
$18,854.83 |
| Rate for Payer: EPIC Health Plan Medicare |
$14,070.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,070.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,181.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,854.83
|
|
|
OTITIS MEDIA AND URI WITHOUT MCC
|
Facility
|
IP
|
$12,037.01
|
|
|
Service Code
|
MSDRG 153
|
| Min. Negotiated Rate |
$8,982.84 |
| Max. Negotiated Rate |
$12,037.01 |
| Rate for Payer: EPIC Health Plan Medicare |
$8,982.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,982.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,330.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,037.01
|
|
|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
|
IP
|
$133.20
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Adventist Health Commercial |
$26.64
|
| Rate for Payer: Adventist Health Commercial |
$28.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.26
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.89
|
| Rate for Payer: Heritage Provider Network Senior |
$64.89
|
| Rate for Payer: Heritage Provider Network Senior |
$61.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Multiplan Commercial |
$99.90
|
| Rate for Payer: Multiplan Commercial |
$105.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.10
|
|
|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
|
OP
|
$133.20
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Adventist Health Commercial |
$26.64
|
| Rate for Payer: Adventist Health Commercial |
$28.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.67
|
| Rate for Payer: Heritage Provider Network Senior |
$64.89
|
| Rate for Payer: Heritage Provider Network Senior |
$61.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$93.24
|
| Rate for Payer: Multiplan Commercial |
$105.12
|
| Rate for Payer: Multiplan Commercial |
$99.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$53.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$56.06
|
| Rate for Payer: TriValley Medical Group Senior |
$53.28
|
| Rate for Payer: TriValley Medical Group Senior |
$56.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.14
|
| Rate for Payer: Vantage Medical Group Senior |
$119.14
|
| Rate for Payer: Vantage Medical Group Senior |
$113.22
|
|
|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
|
OP
|
$13.56
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$11.53 |
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$4.61
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.49
|
| Rate for Payer: Multiplan Commercial |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$10.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.98
|
| Rate for Payer: TriValley Medical Group Senior |
$5.42
|
| Rate for Payer: TriValley Medical Group Senior |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
|
IP
|
$13.56
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.41
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Senior |
$4.61
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.49
|
| Rate for Payer: Multiplan Commercial |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$7.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.49
|
|
|
OXACILLIN 2 GRAM SOLUTION FOR INJECTION [5926]
|
Facility
|
OP
|
$10.80
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Adventist Health Commercial |
$5.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.98
|
| Rate for Payer: Heritage Provider Network Senior |
$12.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.00
|
| Rate for Payer: Heritage Provider Network Senior |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.98
|
| Rate for Payer: Multiplan Commercial |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$21.02
|
| Rate for Payer: Multiplan Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.21
|
| Rate for Payer: TriValley Medical Group Senior |
$11.21
|
| Rate for Payer: TriValley Medical Group Senior |
$10.85
|
| Rate for Payer: TriValley Medical Group Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.05
|
| Rate for Payer: Vantage Medical Group Senior |
$9.18
|
| Rate for Payer: Vantage Medical Group Senior |
$23.83
|
| Rate for Payer: Vantage Medical Group Senior |
$23.05
|
|
|
OXACILLIN 2 GRAM SOLUTION FOR INJECTION [5926]
|
Facility
|
IP
|
$28.03
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: Adventist Health Commercial |
$5.61
|
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.96
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.56
|
| Rate for Payer: Heritage Provider Network Senior |
$12.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.00
|
| Rate for Payer: Heritage Provider Network Senior |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$21.02
|
| Rate for Payer: Multiplan Commercial |
$8.10
|
| Rate for Payer: Multiplan Commercial |
$20.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.98
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$20.11 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1.73
|
| Rate for Payer: TriValley Medical Group Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.43
|
|
|
OXALIPLATIN 100 MG INTRAVENOUS SOLUTION [23929]
|
Facility
|
IP
|
$126.48
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Adventist Health Commercial |
$25.30
|
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$409.58
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$292.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.47
|
| Rate for Payer: Heritage Provider Network Senior |
$294.47
|
| Rate for Payer: Heritage Provider Network Senior |
$58.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$94.86
|
| Rate for Payer: Multiplan Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$229.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$210.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.88
|
|
|
OXALIPLATIN 100 MG INTRAVENOUS SOLUTION [23929]
|
Facility
|
OP
|
$126.48
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$107.51 |
| Rate for Payer: Adventist Health Commercial |
$25.30
|
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$393.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$349.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$477.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$292.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$540.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$540.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$107.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$540.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.56
|
| Rate for Payer: Heritage Provider Network Senior |
$294.47
|
| Rate for Payer: Heritage Provider Network Senior |
$58.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$303.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$445.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$88.54
|
| Rate for Payer: Multiplan Commercial |
$477.00
|
| Rate for Payer: Multiplan Commercial |
$94.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$50.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$254.40
|
| Rate for Payer: TriValley Medical Group Senior |
$50.59
|
| Rate for Payer: TriValley Medical Group Senior |
$254.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$229.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$210.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$540.60
|
| Rate for Payer: Vantage Medical Group Senior |
$540.60
|
| Rate for Payer: Vantage Medical Group Senior |
$107.51
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.86
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$20.11 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1.44
|
| Rate for Payer: TriValley Medical Group Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
OXALIPLATIN 50 MG INTRAVENOUS SOLUTION [23928]
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.79
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.23
|
| Rate for Payer: Heritage Provider Network Senior |
$147.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$114.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.29
|
|
|
OXALIPLATIN 50 MG INTRAVENOUS SOLUTION [23928]
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.23
|
| Rate for Payer: Heritage Provider Network Senior |
$147.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$151.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$222.60
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$114.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.30
|
| Rate for Payer: Vantage Medical Group Senior |
$270.30
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 6275618388
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
|
