|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 03C23ZZ
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047A04Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 03CJ3Z7
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 0270066
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02730G6
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 047L34Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 037L47Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 037837Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 021048C
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02H13YZ
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02H43YZ
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02730FZ
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 037N34Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 037V04Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02H740Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 021248C
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 037H37Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02CH0ZZ
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 4A043B1
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
Cardiovascular Surgery - #2635
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 027P34Z
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]
|
Facility
OP
|
$595.84
|
|
|
Service Code
|
CPT J9047
|
| Hospital Charge Code |
ERX222456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.08 |
| Max. Negotiated Rate |
$506.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$58.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.85
|
| Rate for Payer: BCBS Transplant Transplant |
$357.50
|
| Rate for Payer: Blue Shield of California Commercial |
$439.13
|
| Rate for Payer: Blue Shield of California EPN |
$48.71
|
| Rate for Payer: Cash Price |
$268.13
|
| Rate for Payer: Cash Price |
$268.13
|
| Rate for Payer: Cigna of CA HMO |
$417.09
|
| Rate for Payer: Cigna of CA PPO |
$417.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.63
|
| Rate for Payer: Dignity Health Media |
$47.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.08
|
| Rate for Payer: Galaxy Health WC |
$506.46
|
| Rate for Payer: Global Benefits Group Commercial |
$357.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$446.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.22
|
| Rate for Payer: Heritage Provider Network Transplant |
$77.22
|
| Rate for Payer: IEHP Medi-Cal |
$76.28
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$76.28
|
| Rate for Payer: IEHP Medicare Advantage |
$47.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$397.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.09
|
| Rate for Payer: Multiplan Commercial |
$476.67
|
| Rate for Payer: Networks By Design Commercial |
$297.92
|
| Rate for Payer: Prime Health Services Commercial |
$506.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.92
|
| Rate for Payer: United Healthcare All Other HMO |
$297.92
|
| Rate for Payer: United Healthcare HMO Rider |
$297.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.79
|
| Rate for Payer: Vantage Medical Group Senior |
$47.08
|
|
|
CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]
|
Facility
IP
|
$595.84
|
|
|
Service Code
|
CPT J9047
|
| Hospital Charge Code |
ERX222456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$506.46 |
| Rate for Payer: Blue Shield of California Commercial |
$424.24
|
| Rate for Payer: Blue Shield of California EPN |
$305.07
|
| Rate for Payer: Cash Price |
$268.13
|
| Rate for Payer: Cigna of CA HMO |
$417.09
|
| Rate for Payer: Cigna of CA PPO |
$417.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$238.34
|
| Rate for Payer: Galaxy Health WC |
$506.46
|
| Rate for Payer: Global Benefits Group Commercial |
$357.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$397.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.00
|
| Rate for Payer: Multiplan Commercial |
$476.67
|
| Rate for Payer: Networks By Design Commercial |
$297.92
|
| Rate for Payer: Prime Health Services Commercial |
$506.46
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]
|
Facility
OP
|
$1,787.52
|
|
|
Service Code
|
CPT J9047
|
| Hospital Charge Code |
ERX214890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.08 |
| Max. Negotiated Rate |
$1,519.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$58.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.85
|
| Rate for Payer: BCBS Transplant Transplant |
$1,072.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.40
|
| Rate for Payer: Blue Shield of California EPN |
$48.71
|
| Rate for Payer: Cash Price |
$804.38
|
| Rate for Payer: Cash Price |
$804.38
|
| Rate for Payer: Cigna of CA HMO |
$1,251.26
|
| Rate for Payer: Cigna of CA PPO |
$1,251.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.63
|
| Rate for Payer: Dignity Health Media |
$47.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.08
|
| Rate for Payer: Galaxy Health WC |
$1,519.39
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,340.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.22
|
| Rate for Payer: Heritage Provider Network Transplant |
$77.22
|
| Rate for Payer: IEHP Medi-Cal |
$76.28
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$76.28
|
| Rate for Payer: IEHP Medicare Advantage |
$47.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,192.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.09
|
| Rate for Payer: Multiplan Commercial |
$1,430.02
|
| Rate for Payer: Networks By Design Commercial |
$893.76
|
| Rate for Payer: Prime Health Services Commercial |
$1,519.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,072.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,072.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$893.76
|
| Rate for Payer: United Healthcare All Other HMO |
$893.76
|
| Rate for Payer: United Healthcare HMO Rider |
$893.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$893.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.79
|
| Rate for Payer: Vantage Medical Group Senior |
$47.08
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]
|
Facility
IP
|
$1,787.52
|
|
|
Service Code
|
CPT J9047
|
| Hospital Charge Code |
ERX214890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$1,519.39 |
| Rate for Payer: Blue Shield of California Commercial |
$1,272.71
|
| Rate for Payer: Blue Shield of California EPN |
$915.21
|
| Rate for Payer: Cash Price |
$804.38
|
| Rate for Payer: Cigna of CA HMO |
$1,251.26
|
| Rate for Payer: Cigna of CA PPO |
$1,251.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$715.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$715.01
|
| Rate for Payer: Galaxy Health WC |
$1,519.39
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,192.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$681.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.00
|
| Rate for Payer: Multiplan Commercial |
$1,430.02
|
| Rate for Payer: Networks By Design Commercial |
$893.76
|
| Rate for Payer: Prime Health Services Commercial |
$1,519.39
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]
|
Facility
OP
|
$3,575.04
|
|
|
Service Code
|
NDC 76075-101-01
|
| Hospital Charge Code |
1755799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$858.01 |
| Max. Negotiated Rate |
$3,038.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,344.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,966.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,966.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,130.01
|
| Rate for Payer: BCBS Transplant Transplant |
$2,145.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2,634.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,087.82
|
| Rate for Payer: Cash Price |
$1,608.77
|
| Rate for Payer: Cash Price |
$1,608.77
|
| Rate for Payer: Cigna of CA HMO |
$2,502.53
|
| Rate for Payer: Cigna of CA PPO |
$2,502.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.78
|
| Rate for Payer: Dignity Health Media |
$3,038.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,038.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,430.02
|
| Rate for Payer: Galaxy Health WC |
$3,038.78
|
| Rate for Payer: Global Benefits Group Commercial |
$2,145.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,681.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,384.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.01
|
| Rate for Payer: Multiplan Commercial |
$2,860.03
|
| Rate for Payer: Networks By Design Commercial |
$1,787.52
|
| Rate for Payer: Prime Health Services Commercial |
$3,038.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,145.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,145.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,787.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,787.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,787.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,038.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3,038.78
|
|
