|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$103,591.34
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$79,465.47 |
| Max. Negotiated Rate |
$103,591.34 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79,465.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103,591.34
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$61,725.28
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$47,349.79 |
| Max. Negotiated Rate |
$61,725.28 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47,349.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61,725.28
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$54,826.51
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$42,057.71 |
| Max. Negotiated Rate |
$54,826.51 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42,057.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,826.51
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
|
IP
|
$294.35
|
|
|
Service Code
|
NDC 0078-0883-61
|
| Hospital Charge Code |
NDG225907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.64 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Blue Shield of California Commercial |
$209.58
|
| Rate for Payer: Blue Shield of California EPN |
$150.71
|
| 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: EPIC Health Plan Commercial |
$117.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$117.74
|
| Rate for Payer: Galaxy Health WC |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$176.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.15
|
| 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 |
$111.15
|
| Rate for Payer: United Healthcare All Other HMO |
$108.56
|
| Rate for Payer: United Healthcare HMO Rider |
$106.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.14
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
|
OP
|
$294.35
|
|
|
Service Code
|
NDC 0078-0883-61
|
| Hospital Charge Code |
NDG225907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.64 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$193.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$250.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.37
|
| Rate for Payer: Blue Distinction Transplant |
$176.61
|
| Rate for Payer: Blue Shield of California Commercial |
$216.94
|
| Rate for Payer: Blue Shield of California EPN |
$171.90
|
| 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 |
$250.20
|
| Rate for Payer: Dignity Health Media |
$250.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$117.74
|
| Rate for Payer: Galaxy Health WC |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$176.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$220.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.15
|
| 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: 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 |
$147.18
|
| Rate for Payer: United Healthcare All Other HMO |
$147.18
|
| Rate for Payer: United Healthcare HMO Rider |
$147.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$250.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.20
|
| Rate for Payer: Vantage Medical Group Senior |
$250.20
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
|
OP
|
$423.16
|
|
|
Service Code
|
NDC 0069-8140-20
|
| Hospital Charge Code |
1712554
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$101.56 |
| Max. Negotiated Rate |
$359.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$277.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.12
|
| Rate for Payer: Blue Distinction Transplant |
$253.90
|
| Rate for Payer: Blue Shield of California Commercial |
$311.87
|
| Rate for Payer: Blue Shield of California EPN |
$247.13
|
| Rate for Payer: Cash Price |
$190.42
|
| Rate for Payer: Cigna of CA HMO |
$296.21
|
| Rate for Payer: Cigna of CA PPO |
$296.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.69
|
| Rate for Payer: Dignity Health Media |
$359.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.26
|
| Rate for Payer: Galaxy Health WC |
$359.69
|
| Rate for Payer: Global Benefits Group Commercial |
$253.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$317.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.56
|
| Rate for Payer: Multiplan Commercial |
$338.53
|
| Rate for Payer: Networks By Design Commercial |
$275.05
|
| Rate for Payer: Prime Health Services Commercial |
$359.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.58
|
| Rate for Payer: United Healthcare All Other HMO |
$211.58
|
| Rate for Payer: United Healthcare HMO Rider |
$211.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$359.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.69
|
| Rate for Payer: Vantage Medical Group Senior |
$359.69
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
|
IP
|
$423.16
|
|
|
Service Code
|
NDC 0069-8140-20
|
| Hospital Charge Code |
1712554
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$101.56 |
| Max. Negotiated Rate |
$359.69 |
| Rate for Payer: Blue Shield of California Commercial |
$301.29
|
| Rate for Payer: Blue Shield of California EPN |
$216.66
|
| Rate for Payer: Cash Price |
$190.42
|
| Rate for Payer: Cigna of CA HMO |
$296.21
|
| Rate for Payer: Cigna of CA PPO |
$296.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.26
|
| Rate for Payer: Galaxy Health WC |
$359.69
|
| Rate for Payer: Global Benefits Group Commercial |
$253.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.56
|
| Rate for Payer: Multiplan Commercial |
$338.53
|
| Rate for Payer: Networks By Design Commercial |
$275.05
|
| Rate for Payer: Prime Health Services Commercial |
$359.69
|
|
|
CROMOLYN 20 MG/2 ML SOLUTION FOR NEBULIZATION [9690]
|
Facility
|
OP
|
$10.85
|
|
|
Service Code
|
NDC 69784-205-60
|
| Hospital Charge Code |
1781097
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.46
|
| Rate for Payer: Blue Distinction Transplant |
$6.51
|
| Rate for Payer: Blue Shield of California Commercial |
$8.00
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cigna of CA HMO |
$7.60
|
| Rate for Payer: Cigna of CA PPO |
$7.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.22
|
| Rate for Payer: Dignity Health Media |
$9.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$9.22
|
| Rate for Payer: Global Benefits Group Commercial |
$6.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$8.68
|
| Rate for Payer: Networks By Design Commercial |
$7.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.42
|
| Rate for Payer: United Healthcare All Other HMO |
$5.42
|
| Rate for Payer: United Healthcare HMO Rider |
$5.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.22
|
| Rate for Payer: Vantage Medical Group Senior |
$9.22
|
|
|
CROMOLYN 20 MG/2 ML SOLUTION FOR NEBULIZATION [9690]
|
Facility
|
IP
|
$10.85
|
|
|
Service Code
|
NDC 69784-205-60
|
| Hospital Charge Code |
1781097
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Blue Shield of California Commercial |
$7.73
|
| Rate for Payer: Blue Shield of California EPN |
$5.56
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cigna of CA HMO |
$7.60
|
| Rate for Payer: Cigna of CA PPO |
$7.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$9.22
|
| Rate for Payer: Global Benefits Group Commercial |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$8.68
|
| Rate for Payer: Networks By Design Commercial |
$7.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.22
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 17478-291-11
|
| Hospital Charge Code |
1744076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.63
|
| Rate for Payer: Blue Distinction Transplant |
$1.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$1.92
|
| Rate for Payer: Cigna of CA PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.33
|
| Rate for Payer: Dignity Health Media |
$2.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.10
|
| Rate for Payer: Galaxy Health WC |
$2.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Networks By Design Commercial |
$1.78
|
| Rate for Payer: Prime Health Services Commercial |
$2.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1.37
|
| Rate for Payer: United Healthcare HMO Rider |
$1.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.33
|
| Rate for Payer: Vantage Medical Group Senior |
$2.33
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 61314-237-10
|
| Hospital Charge Code |
1744076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.61
|
| Rate for Payer: Blue Distinction Transplant |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.99
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| 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 |
$2.30
|
| Rate for Payer: Dignity Health Media |
$2.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| 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 |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
| 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 |
$2.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2.30
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 61314-237-10
|
| Hospital Charge Code |
1744076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.38
|
| 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: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| 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 |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 17478-291-11
|
| Hospital Charge Code |
1744076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$1.92
|
| Rate for Payer: Cigna of CA PPO |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.10
|
| Rate for Payer: Galaxy Health WC |
$2.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Networks By Design Commercial |
$1.78
|
| Rate for Payer: Prime Health Services Commercial |
$2.33
|
|
|
CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR INJECTION [29313]
|
Facility
|
OP
|
$3,837.60
|
|
|
Service Code
|
CPT J0840
|
| Hospital Charge Code |
1759986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$921.02 |
| Max. Negotiated Rate |
$12,263.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,263.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,437.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,144.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,144.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,332.31
|
| Rate for Payer: Blue Distinction Transplant |
$2,302.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,828.31
|
| Rate for Payer: Blue Shield of California EPN |
$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 |
$2,924.88
|
| Rate for Payer: Dignity Health Media |
$1,949.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,144.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,632.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,949.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,949.92
|
| Rate for Payer: Galaxy Health WC |
$3,261.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2,302.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,878.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,197.86
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,197.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,158.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,158.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,949.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,559.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,713.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,949.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,456.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,612.89
|
| 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 |
$1,918.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1,918.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1,918.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,918.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,924.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,144.91
|
| Rate for Payer: Vantage Medical Group Senior |
$1,949.92
|
|
|
CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR INJECTION [29313]
|
Facility
|
IP
|
$3,837.60
|
|
|
Service Code
|
CPT J0840
|
| Hospital Charge Code |
1759986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$921.02 |
| Max. Negotiated Rate |
$3,261.96 |
| Rate for Payer: Blue Shield of California Commercial |
$2,732.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,964.85
|
| 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: EPIC Health Plan Commercial |
$1,535.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$2,559.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,462.13
|
| 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 |
$1,449.08
|
| Rate for Payer: United Healthcare All Other HMO |
$1,415.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1,384.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,266.41
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
OP
|
$3.15
|
|
|
Service Code
|
NDC 0409-4092-01
|
| Hospital Charge Code |
NDG110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: Blue Distinction Transplant |
$1.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.68
|
| Rate for Payer: Dignity Health Media |
$2.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2.68
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
OP
|
$3.15
|
|
|
Service Code
|
NDC 0409-4092-11
|
| Hospital Charge Code |
NDG110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: Blue Distinction Transplant |
$1.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.68
|
| Rate for Payer: Dignity Health Media |
$2.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2.68
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 9994-0804-25
|
| Hospital Charge Code |
ERX110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.55
|
| Rate for Payer: Blue Distinction Transplant |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.66
|
| Rate for Payer: Cigna of CA PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Media |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
IP
|
$3.15
|
|
|
Service Code
|
NDC 0409-4092-11
|
| Hospital Charge Code |
NDG110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 9994-0804-25
|
| Hospital Charge Code |
ERX110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
IP
|
$3.15
|
|
|
Service Code
|
NDC 0409-4092-01
|
| Hospital Charge Code |
NDG110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$20,306.12
|
|
|
Service Code
|
APR-DRG 0453
|
| Min. Negotiated Rate |
$15,576.93 |
| Max. Negotiated Rate |
$20,306.12 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,576.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,306.12
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$15,170.17
|
|
|
Service Code
|
APR-DRG 0452
|
| Min. Negotiated Rate |
$11,637.12 |
| Max. Negotiated Rate |
$15,170.17 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,637.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,170.17
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$30,524.79
|
|
|
Service Code
|
APR-DRG 0454
|
| Min. Negotiated Rate |
$23,415.73 |
| Max. Negotiated Rate |
$30,524.79 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,415.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,524.79
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$12,263.47
|
|
|
Service Code
|
APR-DRG 0451
|
| Min. Negotiated Rate |
$9,407.38 |
| Max. Negotiated Rate |
$12,263.47 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,407.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,263.47
|
|
