|
Coronary Surgery
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 041J4KG
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 041C4ZJ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 041C0Z9
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 04R14JZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 04R80KZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 03U207Z
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
OP
|
$10,248.72
|
|
|
Service Code
|
CPT J0801
|
| Hospital Charge Code |
NDG9685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,459.69 |
| Max. Negotiated Rate |
$25,757.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,757.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25,757.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,119.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,119.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,504.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,504.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,866.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,106.19
|
| Rate for Payer: BCBS Transplant Transplant |
$4,900.90
|
| Rate for Payer: BCBS Transplant Transplant |
$6,149.23
|
| Rate for Payer: Blue Shield of California Commercial |
$6,019.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7,553.31
|
| Rate for Payer: Blue Shield of California EPN |
$4,770.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,985.25
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cigna of CA HMO |
$7,174.10
|
| Rate for Payer: Cigna of CA HMO |
$5,717.71
|
| Rate for Payer: Cigna of CA PPO |
$7,174.10
|
| Rate for Payer: Cigna of CA PPO |
$5,717.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Dignity Health Media |
$4,095.32
|
| Rate for Payer: Dignity Health Media |
$4,095.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,504.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,504.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,528.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,528.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,095.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,095.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,095.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,095.32
|
| Rate for Payer: Galaxy Health WC |
$8,711.41
|
| Rate for Payer: Galaxy Health WC |
$6,942.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4,900.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,149.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,126.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,686.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,716.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,716.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,716.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,716.32
|
| Rate for Payer: IEHP Medi-Cal |
$6,634.42
|
| Rate for Payer: IEHP Medi-Cal |
$6,634.42
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,634.42
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,634.42
|
| Rate for Payer: IEHP Medicare Advantage |
$4,095.32
|
| Rate for Payer: IEHP Medicare Advantage |
$4,095.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,448.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,835.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,789.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,789.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,095.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,095.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,960.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,459.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,160.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,160.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,487.73
|
| Rate for Payer: Multiplan Commercial |
$8,198.98
|
| Rate for Payer: Multiplan Commercial |
$6,534.53
|
| Rate for Payer: Networks By Design Commercial |
$5,124.36
|
| Rate for Payer: Networks By Design Commercial |
$4,084.08
|
| Rate for Payer: Prime Health Services Commercial |
$6,942.94
|
| Rate for Payer: Prime Health Services Commercial |
$8,711.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,900.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,149.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,149.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,900.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,124.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,084.08
|
| Rate for Payer: United Healthcare All Other HMO |
$5,124.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,084.08
|
| Rate for Payer: United Healthcare HMO Rider |
$4,084.08
|
| Rate for Payer: United Healthcare HMO Rider |
$5,124.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,124.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,084.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,095.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4,095.32
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
IP
|
$10,248.72
|
|
|
Service Code
|
CPT J0801
|
| Hospital Charge Code |
NDG9685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,459.69 |
| Max. Negotiated Rate |
$8,711.41 |
| Rate for Payer: Blue Shield of California Commercial |
$7,297.09
|
| Rate for Payer: Blue Shield of California Commercial |
$5,815.73
|
| Rate for Payer: Blue Shield of California EPN |
$5,247.34
|
| Rate for Payer: Blue Shield of California EPN |
$4,182.10
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cigna of CA HMO |
$5,717.71
|
| Rate for Payer: Cigna of CA HMO |
$7,174.10
|
| Rate for Payer: Cigna of CA PPO |
$7,174.10
|
| Rate for Payer: Cigna of CA PPO |
$5,717.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,099.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,267.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,099.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,267.26
|
| Rate for Payer: Galaxy Health WC |
$6,942.94
|
| Rate for Payer: Galaxy Health WC |
$8,711.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6,149.23
|
| Rate for Payer: Global Benefits Group Commercial |
$4,900.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,835.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,448.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,904.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,112.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,960.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,459.69
|
| Rate for Payer: Multiplan Commercial |
$6,534.53
|
| Rate for Payer: Multiplan Commercial |
$8,198.98
|
| Rate for Payer: Networks By Design Commercial |
$5,124.36
|
| Rate for Payer: Networks By Design Commercial |
$4,084.08
|
| Rate for Payer: Prime Health Services Commercial |
$8,711.41
|
| Rate for Payer: Prime Health Services Commercial |
$6,942.94
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
IP
|
$96.24
|
|
|
Service Code
|
CPT J0834
|
| Hospital Charge Code |
1754264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$81.80 |
| Rate for Payer: Blue Shield of California Commercial |
$68.52
|
| Rate for Payer: Blue Shield of California EPN |
$49.27
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: Multiplan Commercial |
$76.99
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
OP
|
$96.24
|
|
|
Service Code
|
CPT J0834
|
| Hospital Charge Code |
1754264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$227.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$170.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.12
|
| Rate for Payer: BCBS Transplant Transplant |
$57.74
|
| Rate for Payer: Blue Shield of California Commercial |
$70.93
|
| Rate for Payer: Blue Shield of California EPN |
$105.81
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.80
|
| Rate for Payer: Dignity Health Media |
$81.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: Multiplan Commercial |
$76.99
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.12
|
| Rate for Payer: United Healthcare All Other HMO |
$48.12
|
| Rate for Payer: United Healthcare HMO Rider |
$48.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.80
|
| Rate for Payer: Vantage Medical Group Senior |
$81.80
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [239502]
|
Facility
OP
|
$307.20
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
NDG239502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.73 |
| Max. Negotiated Rate |
$1,014.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,014.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$261.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$168.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$168.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.03
|
| Rate for Payer: BCBS Transplant Transplant |
$184.32
|
| Rate for Payer: Blue Shield of California Commercial |
$226.41
|
| Rate for Payer: Blue Shield of California EPN |
$179.40
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$215.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.12
|
| Rate for Payer: Dignity Health Media |
$261.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.88
|
| Rate for Payer: Galaxy Health WC |
$261.12
|
| Rate for Payer: Global Benefits Group Commercial |
$184.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$230.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.73
|
| Rate for Payer: Multiplan Commercial |
$245.76
|
| Rate for Payer: Networks By Design Commercial |
$153.60
|
| Rate for Payer: Prime Health Services Commercial |
$261.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Other HMO |
$153.60
|
| Rate for Payer: United Healthcare HMO Rider |
$153.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$261.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.12
|
| Rate for Payer: Vantage Medical Group Senior |
$261.12
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [239502]
|
Facility
IP
|
$307.20
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
NDG239502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.73 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Blue Shield of California Commercial |
$218.73
|
| Rate for Payer: Blue Shield of California EPN |
$157.29
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$215.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.88
|
| Rate for Payer: Galaxy Health WC |
$261.12
|
| Rate for Payer: Global Benefits Group Commercial |
$184.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.73
|
| Rate for Payer: Multiplan Commercial |
$245.76
|
| Rate for Payer: Networks By Design Commercial |
$153.60
|
| Rate for Payer: Prime Health Services Commercial |
$261.12
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$47,927.77
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$36,765.64 |
| Max. Negotiated Rate |
$47,927.77 |
| Rate for Payer: IEHP Medi-Cal |
$36,765.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47,927.77
|
|
|
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: 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: 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: 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$250.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$161.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$161.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.37
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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: AlphaCare Medical Group Commercial/Exchange |
$359.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$232.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$232.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.12
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$253.90
|
| 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
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 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: AlphaCare Medical Group Commercial/Exchange |
$9.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.46
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$6.51
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.61
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1.62
|
| 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
|
$2.74
|
|
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$2.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.63
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1.64
|
| 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
|
|
