|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$134,910.45
|
|
|
Service Code
|
APR-DRG 1634
|
| Min. Negotiated Rate |
$85,206.60 |
| Max. Negotiated Rate |
$134,910.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$85,206.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101,537.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134,910.45
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$92,221.71
|
|
|
Service Code
|
APR-DRG 1633
|
| Min. Negotiated Rate |
$58,245.29 |
| Max. Negotiated Rate |
$92,221.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$58,245.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69,408.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92,221.71
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$70,093.81
|
|
|
Service Code
|
APR-DRG 1632
|
| Min. Negotiated Rate |
$44,269.78 |
| Max. Negotiated Rate |
$70,093.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$44,269.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52,754.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70,093.81
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$28,678.03
|
|
|
Service Code
|
APR-DRG 2054
|
| Min. Negotiated Rate |
$18,112.44 |
| Max. Negotiated Rate |
$28,678.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,112.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,583.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,678.03
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$7,668.02
|
|
|
Service Code
|
APR-DRG 2051
|
| Min. Negotiated Rate |
$4,842.96 |
| Max. Negotiated Rate |
$7,668.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,842.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,771.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,668.02
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$10,185.77
|
|
|
Service Code
|
APR-DRG 2052
|
| Min. Negotiated Rate |
$6,433.12 |
| Max. Negotiated Rate |
$10,185.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,433.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,666.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,185.77
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$15,523.36
|
|
|
Service Code
|
APR-DRG 2053
|
| Min. Negotiated Rate |
$9,804.23 |
| Max. Negotiated Rate |
$15,523.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,804.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,683.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,523.36
|
|
|
CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]
|
Facility
|
OP
|
$756.96
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.65 |
| Max. Negotiated Rate |
$681.26 |
| Rate for Payer: Adventist Health Commercial |
$151.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.19
|
| Rate for Payer: Blue Shield of California Commercial |
$72.05
|
| Rate for Payer: Blue Shield of California EPN |
$65.50
|
| Rate for Payer: Cash Price |
$340.63
|
| Rate for Payer: Cash Price |
$340.63
|
| Rate for Payer: Central Health Plan Commercial |
$605.57
|
| Rate for Payer: Cigna of CA HMO |
$529.87
|
| Rate for Payer: Cigna of CA PPO |
$529.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.48
|
| Rate for Payer: EPIC Health Plan Senior |
$66.32
|
| Rate for Payer: Galaxy Health WC |
$643.42
|
| Rate for Payer: Global Benefits Group Commercial |
$454.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$681.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$480.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.79
|
| Rate for Payer: Multiplan Commercial |
$567.72
|
| Rate for Payer: Networks By Design Commercial |
$378.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.29
|
| Rate for Payer: Prime Health Services Commercial |
$643.42
|
| Rate for Payer: Prime Health Services Medicare |
$63.91
|
| Rate for Payer: Riverside University Health System MISP |
$66.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$454.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$454.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.09
|
| Rate for Payer: United Healthcare All Other HMO |
$276.52
|
| Rate for Payer: United Healthcare HMO Rider |
$270.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Vantage Medical Group Senior |
$66.32
|
|
|
CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]
|
Facility
|
IP
|
$756.96
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$151.39 |
| Max. Negotiated Rate |
$681.26 |
| Rate for Payer: Adventist Health Commercial |
$151.39
|
| Rate for Payer: Blue Shield of California Commercial |
$607.08
|
| Rate for Payer: Blue Shield of California EPN |
$381.51
|
| Rate for Payer: Cash Price |
$340.63
|
| Rate for Payer: Central Health Plan Commercial |
$605.57
|
| Rate for Payer: Cigna of CA HMO |
$529.87
|
| Rate for Payer: Cigna of CA PPO |
$529.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.78
|
| Rate for Payer: EPIC Health Plan Senior |
$302.78
|
| Rate for Payer: Galaxy Health WC |
$643.42
|
| Rate for Payer: Global Benefits Group Commercial |
$454.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$681.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$480.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$446.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.39
|
| Rate for Payer: Multiplan Commercial |
$567.72
|
| Rate for Payer: Networks By Design Commercial |
$378.48
|
| Rate for Payer: Prime Health Services Commercial |
$643.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.09
|
| Rate for Payer: United Healthcare All Other HMO |
$276.52
|
| Rate for Payer: United Healthcare HMO Rider |
$270.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.90
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]
|
Facility
|
IP
|
$2,270.88
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$454.18 |
| Max. Negotiated Rate |
$2,043.79 |
| Rate for Payer: Adventist Health Commercial |
$454.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,821.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,144.52
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,816.70
|
| Rate for Payer: Cigna of CA HMO |
$1,589.62
|
| Rate for Payer: Cigna of CA PPO |
$1,589.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,589.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.35
|
| Rate for Payer: EPIC Health Plan Senior |
$908.35
|
| Rate for Payer: Galaxy Health WC |
$1,930.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,043.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,442.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,339.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.18
|
| Rate for Payer: Multiplan Commercial |
$1,703.16
|
| Rate for Payer: Networks By Design Commercial |
$1,135.44
|
| Rate for Payer: Prime Health Services Commercial |
$1,930.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$852.26
|
| Rate for Payer: United Healthcare All Other HMO |
$829.55
|
| Rate for Payer: United Healthcare HMO Rider |
$811.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.71
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]
|
Facility
|
OP
|
$2,270.88
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.65 |
| Max. Negotiated Rate |
$2,043.79 |
| Rate for Payer: Adventist Health Commercial |
$454.18
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.19
|
| Rate for Payer: Blue Shield of California Commercial |
$72.05
|
| Rate for Payer: Blue Shield of California EPN |
$65.50
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,816.70
|
| Rate for Payer: Cigna of CA HMO |
$1,589.62
|
| Rate for Payer: Cigna of CA PPO |
$1,589.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,589.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.48
|
| Rate for Payer: EPIC Health Plan Senior |
$66.32
|
| Rate for Payer: Galaxy Health WC |
$1,930.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,043.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,442.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.79
|
| Rate for Payer: Multiplan Commercial |
$1,703.16
|
| Rate for Payer: Networks By Design Commercial |
$1,135.44
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.29
|
| Rate for Payer: Prime Health Services Commercial |
$1,930.25
|
| Rate for Payer: Prime Health Services Medicare |
$63.91
|
| Rate for Payer: Riverside University Health System MISP |
$66.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,362.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,362.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$852.26
|
| Rate for Payer: United Healthcare All Other HMO |
$829.55
|
| Rate for Payer: United Healthcare HMO Rider |
$811.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Vantage Medical Group Senior |
$66.32
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]
|
Facility
|
OP
|
$4,541.75
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.65 |
| Max. Negotiated Rate |
$4,087.57 |
| Rate for Payer: Adventist Health Commercial |
$908.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.19
|
| Rate for Payer: Blue Shield of California Commercial |
$72.05
|
| Rate for Payer: Blue Shield of California EPN |
$65.50
|
| Rate for Payer: Cash Price |
$2,043.79
|
| Rate for Payer: Cash Price |
$2,043.79
|
| Rate for Payer: Central Health Plan Commercial |
$3,633.40
|
| Rate for Payer: Cigna of CA HMO |
$3,179.22
|
| Rate for Payer: Cigna of CA PPO |
$3,179.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,179.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.48
|
| Rate for Payer: EPIC Health Plan Senior |
$66.32
|
| Rate for Payer: Galaxy Health WC |
$3,860.49
|
| Rate for Payer: Global Benefits Group Commercial |
$2,725.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,087.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,884.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.79
|
| Rate for Payer: Multiplan Commercial |
$3,406.31
|
| Rate for Payer: Networks By Design Commercial |
$2,270.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.29
|
| Rate for Payer: Prime Health Services Commercial |
$3,860.49
|
| Rate for Payer: Prime Health Services Medicare |
$63.91
|
| Rate for Payer: Riverside University Health System MISP |
$66.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,725.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,725.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,704.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,659.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1,623.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,487.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Vantage Medical Group Senior |
$66.32
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]
|
Facility
|
IP
|
$4,541.75
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$908.35 |
| Max. Negotiated Rate |
$4,087.57 |
| Rate for Payer: Adventist Health Commercial |
$908.35
|
| Rate for Payer: Blue Shield of California Commercial |
$3,642.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.04
|
| Rate for Payer: Cash Price |
$2,043.79
|
| Rate for Payer: Central Health Plan Commercial |
$3,633.40
|
| Rate for Payer: Cigna of CA HMO |
$3,179.22
|
| Rate for Payer: Cigna of CA PPO |
$3,179.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,179.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,816.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1,816.70
|
| Rate for Payer: Galaxy Health WC |
$3,860.49
|
| Rate for Payer: Global Benefits Group Commercial |
$2,725.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,087.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,884.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,679.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.35
|
| Rate for Payer: Multiplan Commercial |
$3,406.31
|
| Rate for Payer: Networks By Design Commercial |
$2,270.88
|
| Rate for Payer: Prime Health Services Commercial |
$3,860.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,704.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,659.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1,623.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,487.42
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 6958411110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 5022810901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 5022810901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 6958411110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
CARMUSTINE 100 MG INTRAVENOUS POWDER FOR SOLUTION [28911]
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Adventist Health Commercial |
$84.24
|
| Rate for Payer: Blue Shield of California Commercial |
$519.70
|
| Rate for Payer: Blue Shield of California Commercial |
$337.80
|
| Rate for Payer: Blue Shield of California EPN |
$212.28
|
| Rate for Payer: Blue Shield of California EPN |
$326.59
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: Central Health Plan Commercial |
$336.96
|
| Rate for Payer: Cigna of CA HMO |
$294.84
|
| Rate for Payer: Cigna of CA HMO |
$453.60
|
| Rate for Payer: Cigna of CA PPO |
$294.84
|
| Rate for Payer: Cigna of CA PPO |
$453.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$294.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$168.48
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Galaxy Health WC |
$358.02
|
| Rate for Payer: Global Benefits Group Commercial |
$252.72
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$379.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$267.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$382.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.24
|
| Rate for Payer: Multiplan Commercial |
$315.90
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$210.60
|
| Rate for Payer: Networks By Design Commercial |
$324.00
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Prime Health Services Commercial |
$358.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.19
|
| Rate for Payer: United Healthcare All Other HMO |
$236.71
|
| Rate for Payer: United Healthcare All Other HMO |
$153.86
|
| Rate for Payer: United Healthcare HMO Rider |
$150.54
|
| Rate for Payer: United Healthcare HMO Rider |
$231.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.22
|
|
|
CARMUSTINE 100 MG INTRAVENOUS POWDER FOR SOLUTION [28911]
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Adventist Health Commercial |
$84.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$240.01
|
| Rate for Payer: Adventist Health Medi-Cal |
$240.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$286.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$286.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$360.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$360.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$275.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$275.81
|
| Rate for Payer: Blue Shield of California Commercial |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$990.00
|
| Rate for Payer: Blue Shield of California EPN |
$900.00
|
| Rate for Payer: Blue Shield of California EPN |
$900.00
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: Central Health Plan Commercial |
$336.96
|
| Rate for Payer: Cigna of CA HMO |
$453.60
|
| Rate for Payer: Cigna of CA HMO |
$294.84
|
| Rate for Payer: Cigna of CA PPO |
$453.60
|
| Rate for Payer: Cigna of CA PPO |
$294.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$294.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.02
|
| Rate for Payer: EPIC Health Plan Senior |
$264.01
|
| Rate for Payer: EPIC Health Plan Senior |
$264.01
|
| Rate for Payer: Galaxy Health WC |
$358.02
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Global Benefits Group Commercial |
$252.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$379.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$393.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$393.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$240.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$240.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$240.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$240.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$267.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$441.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$441.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$321.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$321.61
|
| Rate for Payer: Multiplan Commercial |
$315.90
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$210.60
|
| Rate for Payer: Networks By Design Commercial |
$324.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$240.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$240.01
|
| Rate for Payer: Prime Health Services Commercial |
$358.02
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Prime Health Services Medicare |
$254.41
|
| Rate for Payer: Prime Health Services Medicare |
$254.41
|
| Rate for Payer: Riverside University Health System MISP |
$264.01
|
| Rate for Payer: Riverside University Health System MISP |
$264.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.19
|
| Rate for Payer: United Healthcare All Other HMO |
$153.86
|
| Rate for Payer: United Healthcare All Other HMO |
$236.71
|
| Rate for Payer: United Healthcare HMO Rider |
$231.60
|
| Rate for Payer: United Healthcare HMO Rider |
$150.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$240.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$240.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Vantage Medical Group Senior |
$264.01
|
| Rate for Payer: Vantage Medical Group Senior |
$264.01
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
|
IP
|
$62,915.57
|
|
|
Service Code
|
MSDRG 035
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$62,915.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62,915.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40,640.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56,898.68
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,887.96
|
| Rate for Payer: EPIC Health Plan Senior |
$37,258.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,871.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47,420.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,387.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$33,871.49
|
| Rate for Payer: Prime Health Services Medicare |
$35,903.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$101,872.95
|
|
|
Service Code
|
MSDRG 034
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$101,872.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101,872.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65,805.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92,130.40
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$89,572.68
|
| Rate for Payer: EPIC Health Plan Senior |
$59,715.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54,286.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76,001.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$72,743.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$54,286.47
|
| Rate for Payer: Prime Health Services Medicare |
$57,543.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$51,132.55
|
|
|
Service Code
|
MSDRG 036
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$51,132.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51,132.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33,029.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,242.53
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,699.72
|
| Rate for Payer: EPIC Health Plan Senior |
$30,466.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,696.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,775.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37,113.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27,696.80
|
| Rate for Payer: Prime Health Services Medicare |
$29,358.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
CARTILAGE GRAFT; COSTOCHONDRAL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 20910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$950.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$364.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
CARTILAGE GRAFT; NASAL SEPTUM
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 20912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$153.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,557.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,557.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,557.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,411.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,013.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,557.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,013.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,474.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$153.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,380.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,107.48
|
| Rate for Payer: Multiplan WC |
$7,411.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Preferred Health Network WC |
$7,562.79
|
| Rate for Payer: Prime Health Services Medicare |
$4,831.29
|
| Rate for Payer: Prime Health Services WC |
$7,335.91
|
| Rate for Payer: Riverside University Health System MISP |
$5,013.60
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,557.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,836.73
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 5107993120
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
