|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
IP
|
$2.84
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.95
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
IP
|
$87.37
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32469
|
|
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: Adventist Health Commercial |
$13.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.02
|
| Rate for Payer: Cash Price |
$29.97
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.15
|
| Rate for Payer: Heritage Provider Network Senior |
$45.09
|
| Rate for Payer: Heritage Provider Network Senior |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.65
|
| Rate for Payer: Multiplan Commercial |
$65.53
|
| Rate for Payer: Multiplan Commercial |
$49.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.19
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
OP
|
$66.60
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Adventist Health Commercial |
$13.32
|
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cash Price |
$29.97
|
| Rate for Payer: Cash Price |
$29.97
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.61
|
| Rate for Payer: Dignity Health Senior |
$74.26
|
| Rate for Payer: Dignity Health Senior |
$56.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.45
|
| Rate for Payer: Heritage Provider Network Senior |
$30.84
|
| Rate for Payer: Heritage Provider Network Senior |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.65
|
| Rate for Payer: Multiplan Commercial |
$65.53
|
| Rate for Payer: Multiplan Commercial |
$49.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.61
|
| Rate for Payer: Vantage Medical Group Senior |
$56.61
|
| Rate for Payer: Vantage Medical Group Senior |
$74.26
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [32470]
|
Facility
IP
|
$3.27
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Adventist Health Commercial |
$0.93
|
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.21
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2.21
|
| Rate for Payer: Heritage Provider Network Senior |
$3.16
|
| Rate for Payer: Heritage Provider Network Senior |
$4.47
|
| Rate for Payer: Heritage Provider Network Senior |
$6.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Multiplan Commercial |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$6.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.09
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [32470]
|
Facility
OP
|
$9.25
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$14.54 |
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$0.93
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.97
|
| Rate for Payer: Dignity Health Senior |
$2.78
|
| Rate for Payer: Dignity Health Senior |
$3.97
|
| Rate for Payer: Dignity Health Senior |
$7.86
|
| Rate for Payer: Dignity Health Senior |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.16
|
| Rate for Payer: Heritage Provider Network Senior |
$4.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Multiplan Commercial |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.86
|
| Rate for Payer: Vantage Medical Group Senior |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$3.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7.86
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
OP
|
$6.43
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
1752190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$14.54 |
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$2.86
|
| 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 |
$2.89
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.85
|
| Rate for Payer: Dignity Health Senior |
$5.47
|
| Rate for Payer: Dignity Health Senior |
$5.41
|
| Rate for Payer: Dignity Health Senior |
$14.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.94
|
| 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 |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.85
|
| 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 Senior |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
IP
|
$17.47
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
1752190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.00
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.35
|
| Rate for Payer: Heritage Provider Network Senior |
$4.31
|
| Rate for Payer: Heritage Provider Network Senior |
$11.83
|
| Rate for Payer: Heritage Provider Network Senior |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.84
|
|
|
Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26951
|
| Min. Negotiated Rate |
$2,869.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with local advancement flaps (V-Y, hood)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26952
|
| Min. Negotiated Rate |
$484.96 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$484.96
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Amputation, foot; transmetatarsal
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 28805
|
| Min. Negotiated Rate |
$658.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$658.04
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Amputation, metacarpal, with finger or thumb (ray amputation), single, with or without interosseous transfer
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26910
|
| Min. Negotiated Rate |
$530.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$530.26
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
IP
|
$34,744.76
|
|
|
Service Code
|
APR-DRG 3054
|
| Min. Negotiated Rate |
$34,744.76 |
| Max. Negotiated Rate |
$34,744.76 |
| Rate for Payer: IEHP Medi-Cal |
$34,744.76
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
IP
|
$12,356.60
|
|
|
Service Code
|
APR-DRG 3052
|
| Min. Negotiated Rate |
$12,356.60 |
| Max. Negotiated Rate |
$12,356.60 |
| Rate for Payer: IEHP Medi-Cal |
$12,356.60
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
IP
|
$9,267.46
|
|
|
Service Code
|
APR-DRG 3051
|
| Min. Negotiated Rate |
$9,267.46 |
| Max. Negotiated Rate |
$9,267.46 |
| Rate for Payer: IEHP Medi-Cal |
$9,267.46
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
IP
|
$18,715.98
|
|
|
Service Code
|
APR-DRG 3053
|
| Min. Negotiated Rate |
$18,715.98 |
| Max. Negotiated Rate |
$18,715.98 |
| Rate for Payer: IEHP Medi-Cal |
$18,715.98
|
|
|
Amputation, toe; interphalangeal joint
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 28825
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$315.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Amputation, toe; metatarsophalangeal joint
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 28820
|
| Min. Negotiated Rate |
$356.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$356.02
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 0172-5241-60
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 0172-5241-60
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
OP
|
$329.59
|
|
|
Service Code
|
CPT J3590
|
| Hospital Charge Code |
1712540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.66 |
| Max. Negotiated Rate |
$280.15 |
| Rate for Payer: Adventist Health Commercial |
$65.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$176.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$226.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$280.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$181.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.19
|
| Rate for Payer: Blue Shield of California Commercial |
$204.68
|
| Rate for Payer: Blue Shield of California EPN |
$193.47
|
| Rate for Payer: Cash Price |
$148.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$151.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.15
|
| Rate for Payer: Dignity Health Senior |
$280.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.60
|
| Rate for Payer: Heritage Provider Network Senior |
$152.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.40
|
| Rate for Payer: Multiplan Commercial |
$247.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$110.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.15
|
| Rate for Payer: Vantage Medical Group Senior |
$280.15
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
IP
|
$329.59
|
|
|
Service Code
|
CPT J3590
|
| Hospital Charge Code |
1712540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.66 |
| Max. Negotiated Rate |
$247.19 |
| Rate for Payer: Adventist Health Commercial |
$65.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$226.43
|
| Rate for Payer: Cash Price |
$148.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$151.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.13
|
| Rate for Payer: Heritage Provider Network Senior |
$223.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.40
|
| Rate for Payer: Multiplan Commercial |
$247.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$110.12
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
IP
|
$7,334.38
|
|
|
Service Code
|
APR-DRG 2261
|
| Min. Negotiated Rate |
$7,334.38 |
| Max. Negotiated Rate |
$7,334.38 |
| Rate for Payer: IEHP Medi-Cal |
$7,334.38
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
IP
|
$9,705.21
|
|
|
Service Code
|
APR-DRG 2262
|
| Min. Negotiated Rate |
$9,705.21 |
| Max. Negotiated Rate |
$9,705.21 |
| Rate for Payer: IEHP Medi-Cal |
$9,705.21
|
|
