|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
OP
|
$8.04
|
|
|
Service Code
|
NDC 4359802028
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California EPN |
$3.92
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.63
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.22
|
| Rate for Payer: TriValley Medical Group Senior |
$3.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Vantage Medical Group Senior |
$6.83
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
OP
|
$8.09
|
|
|
Service Code
|
NDC 0781194339
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.93
|
| Rate for Payer: Blue Shield of California EPN |
$3.95
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.01
|
| Rate for Payer: Heritage Provider Network Senior |
$5.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.66
|
| Rate for Payer: Multiplan Commercial |
$6.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.88
|
| Rate for Payer: Vantage Medical Group Senior |
$6.88
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION [464]
|
Facility
|
IP
|
$57.60
|
|
|
Service Code
|
HCPCS J0285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Adventist Health Commercial |
$11.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.09
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.67
|
| Rate for Payer: Heritage Provider Network Senior |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.07
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION [464]
|
Facility
|
OP
|
$57.60
|
|
|
Service Code
|
HCPCS J0285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$11.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.81
|
| Rate for Payer: Blue Shield of California Commercial |
$51.00
|
| Rate for Payer: Blue Shield of California EPN |
$51.00
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.67
|
| Rate for Payer: Heritage Provider Network Senior |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$27.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.04
|
| Rate for Payer: TriValley Medical Group Senior |
$23.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.96
|
| Rate for Payer: Vantage Medical Group Senior |
$48.96
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
|
OP
|
$305.70
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.85 |
| Max. Negotiated Rate |
$229.28 |
| Rate for Payer: Adventist Health Commercial |
$61.14
|
| Rate for Payer: Adventist Health Commercial |
$78.69
|
| Rate for Payer: Adventist Health Commercial |
$57.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$188.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.97
|
| Rate for Payer: Blue Shield of California Commercial |
$51.97
|
| Rate for Payer: Blue Shield of California Commercial |
$51.97
|
| Rate for Payer: Blue Shield of California EPN |
$51.97
|
| Rate for Payer: Blue Shield of California EPN |
$51.97
|
| Rate for Payer: Blue Shield of California EPN |
$51.97
|
| Rate for Payer: Cash Price |
$177.04
|
| Rate for Payer: Cash Price |
$128.90
|
| Rate for Payer: Cash Price |
$137.56
|
| Rate for Payer: Cash Price |
$128.90
|
| Rate for Payer: Cash Price |
$137.56
|
| Rate for Payer: Cash Price |
$177.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$140.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$251.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.62
|
| Rate for Payer: Heritage Provider Network Senior |
$132.62
|
| Rate for Payer: Heritage Provider Network Senior |
$141.54
|
| Rate for Payer: Heritage Provider Network Senior |
$182.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$187.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$145.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$136.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$229.28
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: Multiplan Commercial |
$295.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$157.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$122.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$114.58
|
| Rate for Payer: TriValley Medical Group Senior |
$122.28
|
| Rate for Payer: TriValley Medical Group Senior |
$157.37
|
| Rate for Payer: TriValley Medical Group Senior |
$114.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$110.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$142.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$130.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$101.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Vantage Medical Group Senior |
$21.84
|
| Rate for Payer: Vantage Medical Group Senior |
$21.84
|
| Rate for Payer: Vantage Medical Group Senior |
$21.84
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
|
IP
|
$393.43
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.21 |
| Max. Negotiated Rate |
$295.07 |
| Rate for Payer: Adventist Health Commercial |
$78.69
|
| Rate for Payer: Adventist Health Commercial |
$57.29
|
| Rate for Payer: Adventist Health Commercial |
$61.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$253.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.47
|
| Rate for Payer: Cash Price |
$177.04
|
| Rate for Payer: Cash Price |
$137.56
|
| Rate for Payer: Cash Price |
$128.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$140.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.54
|
| Rate for Payer: Heritage Provider Network Senior |
$141.54
|
| Rate for Payer: Heritage Provider Network Senior |
$132.62
|
| Rate for Payer: Heritage Provider Network Senior |
$182.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.36
|
| Rate for Payer: Multiplan Commercial |
$295.07
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: Multiplan Commercial |
$229.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$142.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$110.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$130.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$101.22
|
|
|
AMPHOTERICIN ORAL SUSPENSION COMPOUND 5 MG/ML [4080241]
|
Facility
|
OP
|
$4.56
|
|
|
Service Code
|
NDC 9994080241
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Senior |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3.88
|
|
|
AMPHOTERICIN ORAL SUSPENSION COMPOUND 5 MG/ML [4080241]
|
Facility
|
IP
|
$4.56
|
|
|
Service Code
|
NDC 9994080241
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.94
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$16.55
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$38.32
|
| Rate for Payer: Heritage Provider Network Senior |
$36.11
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$39.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.94
|
| Rate for Payer: Multiplan Commercial |
$62.08
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Senior |
$36.00
|
| Rate for Payer: TriValley Medical Group Senior |
$33.11
|
| Rate for Payer: TriValley Medical Group Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.35
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$70.35
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$16.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.23
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.32
|
| Rate for Payer: Heritage Provider Network Senior |
$38.32
|
| Rate for Payer: Heritage Provider Network Senior |
$36.11
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.41
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.74
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.20
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
|
OP
|
$5.81
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$8.48 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$3.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Senior |
$2.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4.94
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.64
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
|
IP
|
$8.53
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Adventist Health Commercial |
$3.22
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.36
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.39
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
|
OP
|
$16.08
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$13.67 |
| Rate for Payer: Adventist Health Commercial |
$3.22
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$12.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.41
|
| Rate for Payer: TriValley Medical Group Senior |
$3.41
|
| Rate for Payer: TriValley Medical Group Senior |
$1.68
|
| Rate for Payer: TriValley Medical Group Senior |
$6.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 0781214501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.40
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 0781214501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
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 |
$8.48 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.09
|
| 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 HMO/PPO |
$8.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.55
|
| 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: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Senior |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.12
|
| 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 |
$0.61 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.18
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.12
|
|
|
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 |
$4.28 |
| Max. Negotiated Rate |
$74.26 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.99
|
| 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 HMO/PPO |
$16.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.19
|
| 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: EPIC Health Plan Commercial |
$55.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.45
|
| Rate for Payer: Heritage Provider Network Senior |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.16
|
| Rate for Payer: Multiplan Commercial |
$65.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.95
|
| Rate for Payer: TriValley Medical Group Senior |
$34.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.93
|
| 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 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 |
$15.81 |
| Max. Negotiated Rate |
$65.53 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.27
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.45
|
| Rate for Payer: Heritage Provider Network Senior |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$65.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.93
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
IP
|
$6.43
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.25
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.25
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2.98
|
| Rate for Payer: Heritage Provider Network Senior |
$8.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.19
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
OP
|
$6.43
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.61
|
| 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 |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.54
|
| 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 HMO/PPO |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.96
|
| 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 Commercial/Exchange |
$5.61
|
| 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 Medi-Cal |
$5.41
|
| 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: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.50
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Senior |
$2.54
|
| Rate for Payer: TriValley Medical Group Senior |
$2.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2.57
|
| Rate for Payer: TriValley Medical Group Senior |
$6.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.85
|
| 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 |
$5.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$14.85
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC
|
Facility
|
IP
|
$44,472.35
|
|
|
Service Code
|
MSDRG 240
|
| Min. Negotiated Rate |
$33,188.32 |
| Max. Negotiated Rate |
$44,472.35 |
| Rate for Payer: EPIC Health Plan Medicare |
$33,188.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,188.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,166.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44,472.35
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
|
IP
|
$76,276.59
|
|
|
Service Code
|
MSDRG 239
|
| Min. Negotiated Rate |
$56,922.83 |
| Max. Negotiated Rate |
$76,276.59 |
| Rate for Payer: EPIC Health Plan Medicare |
$56,922.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,922.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65,461.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76,276.59
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
|
IP
|
$21,959.71
|
|
|
Service Code
|
MSDRG 241
|
| Min. Negotiated Rate |
$16,387.84 |
| Max. Negotiated Rate |
$21,959.71 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,387.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,387.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,846.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,959.71
|
|
