|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$58,097.50
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$46,401.55 |
| Max. Negotiated Rate |
$58,097.50 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46,401.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58,097.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,981.97
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$180,932.81
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$180,932.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$173,719.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$180,932.81
|
| Rate for Payer: EPIC Health Plan Senior |
$120,621.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109,656.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153,518.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146,939.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$148,665.61
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$148,665.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$118,593.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$148,665.61
|
| Rate for Payer: EPIC Health Plan Senior |
$99,110.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90,100.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126,140.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120,734.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
|
OP
|
$294.35
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$814.52 |
| Rate for Payer: Adventist Health Commercial |
$58.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$814.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.36
|
| Rate for Payer: Blue Shield of California Commercial |
$147.18
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cigna of CA HMO |
$206.04
|
| Rate for Payer: Cigna of CA PPO |
$206.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Senior |
$142.93
|
| Rate for Payer: Galaxy Health WC |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$176.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$213.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$129.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$181.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.12
|
| Rate for Payer: Multiplan Commercial |
$235.48
|
| Rate for Payer: Networks By Design Commercial |
$147.18
|
| Rate for Payer: Prime Health Services Commercial |
$250.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.47
|
| Rate for Payer: United Healthcare All Other HMO |
$107.53
|
| Rate for Payer: United Healthcare HMO Rider |
$105.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$129.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.93
|
| Rate for Payer: Vantage Medical Group Senior |
$142.93
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
|
IP
|
$294.35
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: United Healthcare HMO Rider |
$105.20
|
| Rate for Payer: Adventist Health Commercial |
$58.87
|
| Rate for Payer: Blue Shield of California Commercial |
$149.24
|
| Rate for Payer: Blue Shield of California Commercial |
$226.36
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cigna of CA HMO |
$206.04
|
| Rate for Payer: Cigna of CA PPO |
$206.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.74
|
| Rate for Payer: EPIC Health Plan Senior |
$117.74
|
| Rate for Payer: Galaxy Health WC |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$176.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.64
|
| Rate for Payer: Multiplan Commercial |
$235.48
|
| Rate for Payer: Networks By Design Commercial |
$147.18
|
| Rate for Payer: Prime Health Services Commercial |
$250.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.47
|
| Rate for Payer: United Healthcare All Other HMO |
$107.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.40
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
|
OP
|
$475.46
|
|
|
Service Code
|
NDC 0069814020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$95.09 |
| Max. Negotiated Rate |
$404.14 |
| Rate for Payer: Adventist Health Commercial |
$95.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$311.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$404.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$261.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$356.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.10
|
| Rate for Payer: Cash Price |
$213.96
|
| Rate for Payer: Cigna of CA HMO |
$332.82
|
| Rate for Payer: Cigna of CA PPO |
$332.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$404.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$404.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$404.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$332.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.18
|
| Rate for Payer: EPIC Health Plan Senior |
$190.18
|
| Rate for Payer: Galaxy Health WC |
$404.14
|
| Rate for Payer: Global Benefits Group Commercial |
$285.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$301.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$172.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$332.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$332.82
|
| Rate for Payer: Multiplan Commercial |
$380.37
|
| Rate for Payer: Networks By Design Commercial |
$309.05
|
| Rate for Payer: Prime Health Services Commercial |
$404.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$285.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.73
|
| Rate for Payer: United Healthcare All Other HMO |
$237.73
|
| Rate for Payer: United Healthcare HMO Rider |
$237.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$404.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$404.14
|
| Rate for Payer: Vantage Medical Group Senior |
$404.14
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
|
IP
|
$475.46
|
|
|
Service Code
|
NDC 0069814020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$95.09 |
| Max. Negotiated Rate |
$404.14 |
| Rate for Payer: Adventist Health Commercial |
$95.09
|
| Rate for Payer: Blue Shield of California Commercial |
$241.06
|
| Rate for Payer: Blue Shield of California Commercial |
$365.63
|
| Rate for Payer: Cash Price |
$213.96
|
| Rate for Payer: Cigna of CA HMO |
$332.82
|
| Rate for Payer: Cigna of CA PPO |
$332.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$332.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.18
|
| Rate for Payer: EPIC Health Plan Senior |
$190.18
|
| Rate for Payer: Galaxy Health WC |
$404.14
|
| Rate for Payer: Global Benefits Group Commercial |
$285.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$301.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.11
|
| Rate for Payer: Multiplan Commercial |
$380.37
|
| Rate for Payer: Networks By Design Commercial |
$309.05
|
| Rate for Payer: Prime Health Services Commercial |
$404.14
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 6131423710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 6131423710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.73
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
CROMOLYN 5.2 MG/SPRAY (4 %) NASAL SPRAY [24325]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 5778239726
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
CROMOLYN 5.2 MG/SPRAY (4 %) NASAL SPRAY [24325]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 5778239726
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
|
CROTALIDAE POLYVAL IMMUNE FAB 1 GRAM SOLUTION FOR INJECTION [29313]
|
Facility
|
IP
|
$3,837.60
|
|
|
Service Code
|
HCPCS J0840
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$767.52 |
| Max. Negotiated Rate |
$3,261.96 |
| Rate for Payer: Adventist Health Commercial |
$767.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,945.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,951.11
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cigna of CA HMO |
$2,686.32
|
| Rate for Payer: Cigna of CA PPO |
$2,686.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,686.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,535.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1,535.04
|
| Rate for Payer: Galaxy Health WC |
$3,261.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2,302.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,436.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,264.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.02
|
| Rate for Payer: Multiplan Commercial |
$3,070.08
|
| Rate for Payer: Networks By Design Commercial |
$1,918.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,261.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,440.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,401.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1,371.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,256.81
|
|
|
CROTALIDAE POLYVAL IMMUNE FAB 1 GRAM SOLUTION FOR INJECTION [29313]
|
Facility
|
OP
|
$3,837.60
|
|
|
Service Code
|
HCPCS J0840
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$767.52 |
| Max. Negotiated Rate |
$11,043.13 |
| Rate for Payer: Adventist Health Commercial |
$767.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,043.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,383.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,097.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,097.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,192.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,837.60
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cigna of CA HMO |
$2,686.32
|
| Rate for Payer: Cigna of CA PPO |
$2,686.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,383.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,097.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,097.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,686.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,146.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,097.60
|
| Rate for Payer: Galaxy Health WC |
$3,261.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2,302.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,127.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,906.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,906.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,436.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,470.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,669.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,402.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,555.26
|
| Rate for Payer: Multiplan Commercial |
$3,070.08
|
| Rate for Payer: Networks By Design Commercial |
$1,918.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,261.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,302.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,302.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,440.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,401.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1,371.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,256.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,906.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,383.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,097.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,097.60
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
OP
|
$3.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.85
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.23
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
IP
|
$3.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
|
|
CURETTAGE, POSTPARTUM
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 59160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.50 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$340.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$385.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$27,710.93
|
|
|
Service Code
|
APR-DRG 0453
|
| Min. Negotiated Rate |
$22,132.28 |
| Max. Negotiated Rate |
$27,710.93 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,132.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,710.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,793.99
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$20,706.37
|
|
|
Service Code
|
APR-DRG 0452
|
| Min. Negotiated Rate |
$16,537.85 |
| Max. Negotiated Rate |
$20,706.37 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16,537.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,706.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,526.75
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$16,774.47
|
|
|
Service Code
|
APR-DRG 0451
|
| Min. Negotiated Rate |
$13,397.51 |
| Max. Negotiated Rate |
$16,774.47 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,397.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,774.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,008.74
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$56,323.30
|
|
|
Service Code
|
APR-DRG 0454
|
| Min. Negotiated Rate |
$44,984.53 |
| Max. Negotiated Rate |
$56,323.30 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44,984.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56,323.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,394.53
|
|
|
CVL-NICARDIPINE 20 MG/200 ML PREMIX FOR INTRA-ART/INTRA-CORONARY [4081031]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
|
|
CVL-NICARDIPINE 20 MG/200 ML PREMIX FOR INTRA-ART/INTRA-CORONARY [4081031]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
CVL-VERAPAMIL 5MG/50ML NS FOR IA/IC BOLUS [4080934]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
CVL-VERAPAMIL 5MG/50ML NS FOR IA/IC BOLUS [4080934]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]
|
Facility
|
IP
|
$8.39
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California Commercial |
$6.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.34
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$1.85
|
| Rate for Payer: Cigna of CA PPO |
$1.85
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1.06
|
| Rate for Payer: EPIC Health Plan Senior |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$2.11
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$1.32
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.96
|
| Rate for Payer: United Healthcare HMO Rider |
$0.94
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.75
|
|
