|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
CPT J2305
|
| Hospital Charge Code |
1757264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
CPT J2305
|
| Hospital Charge Code |
1757264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$10.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.02
|
| Rate for Payer: Blue Distinction Transplant |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Media |
$1.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.29
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Vantage Medical Group Senior |
$1.29
|
|
|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 9994-0806-95
|
| Hospital Charge Code |
NDC4080695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Blue Distinction Transplant |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: Dignity Health Media |
$0.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
|
|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 9994-0806-95
|
| Hospital Charge Code |
NDC4080695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$311.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.95
|
| Rate for Payer: Blue Distinction Transplant |
$220.15
|
| Rate for Payer: Blue Shield of California Commercial |
$270.41
|
| Rate for Payer: Blue Shield of California EPN |
$32.90
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.63
|
| Rate for Payer: Dignity Health Media |
$31.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.09
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$275.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$50.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$50.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.66
|
| Rate for Payer: Multiplan Commercial |
$293.53
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.46
|
| Rate for Payer: United Healthcare All Other HMO |
$183.46
|
| Rate for Payer: United Healthcare HMO Rider |
$183.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31.09
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.06 |
| Max. Negotiated Rate |
$311.87 |
| Rate for Payer: Blue Shield of California Commercial |
$261.24
|
| Rate for Payer: Blue Shield of California EPN |
$187.86
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.76
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.06
|
| Rate for Payer: Multiplan Commercial |
$293.53
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.55
|
| Rate for Payer: United Healthcare All Other HMO |
$135.32
|
| Rate for Payer: United Healthcare HMO Rider |
$132.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.08
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG220813
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$311.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.95
|
| Rate for Payer: Blue Distinction Transplant |
$220.15
|
| Rate for Payer: Blue Shield of California Commercial |
$270.41
|
| Rate for Payer: Blue Shield of California EPN |
$32.90
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.63
|
| Rate for Payer: Dignity Health Media |
$31.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.09
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$275.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$50.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$50.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.66
|
| Rate for Payer: Multiplan Commercial |
$293.53
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.46
|
| Rate for Payer: United Healthcare All Other HMO |
$183.46
|
| Rate for Payer: United Healthcare HMO Rider |
$183.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31.09
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG220813
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.06 |
| Max. Negotiated Rate |
$311.87 |
| Rate for Payer: Blue Shield of California Commercial |
$261.24
|
| Rate for Payer: Blue Shield of California EPN |
$187.86
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.76
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.06
|
| Rate for Payer: Multiplan Commercial |
$293.53
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.55
|
| Rate for Payer: United Healthcare All Other HMO |
$135.32
|
| Rate for Payer: United Healthcare HMO Rider |
$132.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.08
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
IP
|
$854.85
|
|
|
Service Code
|
CPT J9298
|
| Hospital Charge Code |
NDG233890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$726.62 |
| Rate for Payer: Blue Shield of California Commercial |
$608.65
|
| Rate for Payer: Blue Shield of California EPN |
$437.68
|
| Rate for Payer: Cash Price |
$384.68
|
| Rate for Payer: Cigna of CA HMO |
$598.40
|
| Rate for Payer: Cigna of CA PPO |
$598.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$341.94
|
| Rate for Payer: Galaxy Health WC |
$726.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$683.88
|
| Rate for Payer: Networks By Design Commercial |
$427.42
|
| Rate for Payer: Prime Health Services Commercial |
$726.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.79
|
| Rate for Payer: United Healthcare All Other HMO |
$315.27
|
| Rate for Payer: United Healthcare HMO Rider |
$308.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.10
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
OP
|
$854.85
|
|
|
Service Code
|
CPT J9298
|
| Hospital Charge Code |
NDG233890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.15 |
| Max. Negotiated Rate |
$1,177.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,177.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$233.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.86
|
| Rate for Payer: Blue Distinction Transplant |
$512.91
|
| Rate for Payer: Blue Shield of California Commercial |
$630.02
|
| Rate for Payer: Blue Shield of California EPN |
$499.23
|
| Rate for Payer: Cash Price |
$384.68
|
| Rate for Payer: Cash Price |
$384.68
|
| Rate for Payer: Cigna of CA HMO |
$598.40
|
| Rate for Payer: Cigna of CA PPO |
$598.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$233.94
|
| Rate for Payer: Dignity Health Media |
$205.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$187.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$187.15
|
| Rate for Payer: Galaxy Health WC |
$726.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$641.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$306.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$303.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$303.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$187.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.79
|
| Rate for Payer: Multiplan Commercial |
$683.88
|
| Rate for Payer: Networks By Design Commercial |
$427.42
|
| Rate for Payer: Prime Health Services Commercial |
$726.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$512.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$512.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.42
|
| Rate for Payer: United Healthcare All Other HMO |
$427.42
|
| Rate for Payer: United Healthcare HMO Rider |
$427.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$233.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.87
|
| Rate for Payer: Vantage Medical Group Senior |
$205.87
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.06 |
| Max. Negotiated Rate |
$311.87 |
| Rate for Payer: Blue Shield of California Commercial |
$261.24
|
| Rate for Payer: Blue Shield of California EPN |
$187.86
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.76
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.06
|
| Rate for Payer: Multiplan Commercial |
$293.53
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.55
|
| Rate for Payer: United Healthcare All Other HMO |
$135.32
|
| Rate for Payer: United Healthcare HMO Rider |
$132.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.08
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$311.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.95
|
| Rate for Payer: Blue Distinction Transplant |
$220.15
|
| Rate for Payer: Blue Shield of California Commercial |
$270.41
|
| Rate for Payer: Blue Shield of California EPN |
$32.90
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.63
|
| Rate for Payer: Dignity Health Media |
$31.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.09
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$275.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$50.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$50.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.66
|
| Rate for Payer: Multiplan Commercial |
$293.53
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.46
|
| Rate for Payer: United Healthcare All Other HMO |
$183.46
|
| Rate for Payer: United Healthcare HMO Rider |
$183.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31.09
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
OP
|
$429.49
|
|
|
Service Code
|
CPT 90621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$1,759.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,273.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,759.74
|
| Rate for Payer: Blue Distinction Transplant |
$257.69
|
| Rate for Payer: Blue Shield of California Commercial |
$316.53
|
| Rate for Payer: Blue Shield of California EPN |
$179.72
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Cigna of CA HMO |
$300.64
|
| Rate for Payer: Cigna of CA PPO |
$300.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.07
|
| Rate for Payer: Dignity Health Media |
$365.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.80
|
| Rate for Payer: Galaxy Health WC |
$365.07
|
| Rate for Payer: Global Benefits Group Commercial |
$257.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$322.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.08
|
| Rate for Payer: Multiplan Commercial |
$343.59
|
| Rate for Payer: Networks By Design Commercial |
$214.74
|
| Rate for Payer: Prime Health Services Commercial |
$365.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$257.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$257.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.74
|
| Rate for Payer: United Healthcare All Other HMO |
$214.74
|
| Rate for Payer: United Healthcare HMO Rider |
$214.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.07
|
| Rate for Payer: Vantage Medical Group Senior |
$365.07
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
IP
|
$429.49
|
|
|
Service Code
|
CPT 90621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$365.07 |
| Rate for Payer: Blue Shield of California Commercial |
$305.80
|
| Rate for Payer: Blue Shield of California EPN |
$219.90
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Cigna of CA HMO |
$300.64
|
| Rate for Payer: Cigna of CA PPO |
$300.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.80
|
| Rate for Payer: Galaxy Health WC |
$365.07
|
| Rate for Payer: Global Benefits Group Commercial |
$257.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.08
|
| Rate for Payer: Multiplan Commercial |
$343.59
|
| Rate for Payer: Networks By Design Commercial |
$214.74
|
| Rate for Payer: Prime Health Services Commercial |
$365.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.18
|
| Rate for Payer: United Healthcare All Other HMO |
$158.40
|
| Rate for Payer: United Healthcare HMO Rider |
$154.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.73
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$57,279.20
|
|
|
Service Code
|
APR-DRG 0504
|
| Min. Negotiated Rate |
$43,939.18 |
| Max. Negotiated Rate |
$57,279.20 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43,939.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57,279.20
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$27,963.92
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$21,451.27 |
| Max. Negotiated Rate |
$27,963.92 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21,451.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,963.92
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$17,629.97
|
|
|
Service Code
|
APR-DRG 0502
|
| Min. Negotiated Rate |
$13,524.04 |
| Max. Negotiated Rate |
$17,629.97 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,524.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,629.97
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$10,145.96
|
|
|
Service Code
|
APR-DRG 0501
|
| Min. Negotiated Rate |
$7,783.02 |
| Max. Negotiated Rate |
$10,145.96 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,783.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,145.96
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$29,632.74
|
|
|
Service Code
|
APR-DRG 3232
|
| Min. Negotiated Rate |
$22,731.43 |
| Max. Negotiated Rate |
$29,632.74 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,731.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,632.74
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$55,009.18
|
|
|
Service Code
|
APR-DRG 3234
|
| Min. Negotiated Rate |
$42,197.83 |
| Max. Negotiated Rate |
$55,009.18 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42,197.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55,009.18
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$26,389.08
|
|
|
Service Code
|
APR-DRG 3231
|
| Min. Negotiated Rate |
$20,243.20 |
| Max. Negotiated Rate |
$26,389.08 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,243.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,389.08
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$39,438.20
|
|
|
Service Code
|
APR-DRG 3233
|
| Min. Negotiated Rate |
$30,253.25 |
| Max. Negotiated Rate |
$39,438.20 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30,253.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39,438.20
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$70,135.02
|
|
|
Service Code
|
APR-DRG 3254
|
| Min. Negotiated Rate |
$53,800.95 |
| Max. Negotiated Rate |
$70,135.02 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53,800.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70,135.02
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$32,791.28
|
|
|
Service Code
|
APR-DRG 3251
|
| Min. Negotiated Rate |
$25,154.37 |
| Max. Negotiated Rate |
$32,791.28 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,154.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32,791.28
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$38,171.95
|
|
|
Service Code
|
APR-DRG 3252
|
| Min. Negotiated Rate |
$29,281.90 |
| Max. Negotiated Rate |
$38,171.95 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29,281.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38,171.95
|
|
