|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$64,119.72
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$40,496.66 |
| Max. Negotiated Rate |
$64,119.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$40,496.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48,258.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64,119.72
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$42,930.44
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$27,113.96 |
| Max. Negotiated Rate |
$42,930.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,113.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32,310.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,930.44
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$108,278.83
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$68,386.63 |
| Max. Negotiated Rate |
$108,278.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$68,386.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81,494.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108,278.83
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$150,815.77
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$150,815.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$150,815.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97,420.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136,392.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$131,891.38
|
| Rate for Payer: EPIC Health Plan Senior |
$87,927.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79,934.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111,907.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$107,111.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$79,934.17
|
| Rate for Payer: Prime Health Services Medicare |
$84,730.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$102,957.30
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$102,957.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$102,957.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66,506.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93,111.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$90,510.27
|
| Rate for Payer: EPIC Health Plan Senior |
$60,340.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54,854.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76,796.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73,505.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$54,854.71
|
| Rate for Payer: Prime Health Services Medicare |
$58,145.99
|
| 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
|
|
|
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT)
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 36830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,156.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| 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 |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$202.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Medicare |
$7,586.27
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,872.55
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
|
OP
|
$294.35
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$802.55 |
| Rate for Payer: Adventist Health Commercial |
$58.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$129.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$802.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.26
|
| Rate for Payer: Blue Shield of California Commercial |
$161.90
|
| Rate for Payer: Blue Shield of California EPN |
$147.18
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Central Health Plan Commercial |
$235.48
|
| Rate for Payer: Cigna of CA HMO |
$206.04
|
| Rate for Payer: Cigna of CA PPO |
$206.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Senior |
$142.93
|
| Rate for Payer: Galaxy Health WC |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$176.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$213.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$129.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$181.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174.12
|
| Rate for Payer: Multiplan Commercial |
$220.76
|
| Rate for Payer: Networks By Design Commercial |
$147.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$129.94
|
| Rate for Payer: Prime Health Services Commercial |
$250.20
|
| Rate for Payer: Prime Health Services Medicare |
$137.74
|
| Rate for Payer: Riverside University Health System MISP |
$142.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.47
|
| Rate for Payer: United Healthcare All Other HMO |
$107.53
|
| Rate for Payer: United Healthcare HMO Rider |
$105.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$129.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.93
|
| Rate for Payer: Vantage Medical Group Senior |
$142.93
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
|
IP
|
$294.35
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$264.92 |
| Rate for Payer: Adventist Health Commercial |
$58.87
|
| Rate for Payer: Blue Shield of California Commercial |
$236.07
|
| Rate for Payer: Blue Shield of California EPN |
$148.35
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Central Health Plan Commercial |
$235.48
|
| Rate for Payer: Cigna of CA HMO |
$206.04
|
| Rate for Payer: Cigna of CA PPO |
$206.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.74
|
| Rate for Payer: EPIC Health Plan Senior |
$117.74
|
| Rate for Payer: Galaxy Health WC |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$176.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.87
|
| Rate for Payer: Multiplan Commercial |
$220.76
|
| Rate for Payer: Networks By Design Commercial |
$147.18
|
| Rate for Payer: Prime Health Services Commercial |
$250.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.47
|
| Rate for Payer: United Healthcare All Other HMO |
$107.53
|
| Rate for Payer: United Healthcare HMO Rider |
$105.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.40
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
|
IP
|
$475.46
|
|
|
Service Code
|
NDC 0069814020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$95.09 |
| Max. Negotiated Rate |
$427.91 |
| Rate for Payer: Adventist Health Commercial |
$95.09
|
| Rate for Payer: Blue Shield of California Commercial |
$381.32
|
| Rate for Payer: Blue Shield of California EPN |
$239.63
|
| Rate for Payer: Cash Price |
$213.96
|
| Rate for Payer: Central Health Plan Commercial |
$380.37
|
| Rate for Payer: Cigna of CA HMO |
$332.82
|
| Rate for Payer: Cigna of CA PPO |
$332.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$332.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.18
|
| Rate for Payer: EPIC Health Plan Senior |
$190.18
|
| Rate for Payer: Galaxy Health WC |
$404.14
|
| Rate for Payer: Global Benefits Group Commercial |
$285.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$427.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$301.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$356.60
|
| Rate for Payer: Networks By Design Commercial |
$309.05
|
| Rate for Payer: Prime Health Services Commercial |
$404.14
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
|
OP
|
$475.46
|
|
|
Service Code
|
NDC 0069814020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$95.09 |
| Max. Negotiated Rate |
$427.91 |
| Rate for Payer: Adventist Health Commercial |
$95.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$404.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$261.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$356.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.58
|
| Rate for Payer: Blue Shield of California Commercial |
$301.44
|
| Rate for Payer: Blue Shield of California EPN |
$189.71
|
| Rate for Payer: Cash Price |
$213.96
|
| Rate for Payer: Central Health Plan Commercial |
$380.37
|
| Rate for Payer: Cigna of CA HMO |
$332.82
|
| Rate for Payer: Cigna of CA PPO |
$332.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$404.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$404.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$404.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$332.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.18
|
| Rate for Payer: EPIC Health Plan Senior |
$190.18
|
| Rate for Payer: Galaxy Health WC |
$404.14
|
| Rate for Payer: Global Benefits Group Commercial |
$285.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$427.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$301.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$172.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$332.82
|
| Rate for Payer: Multiplan Commercial |
$356.60
|
| Rate for Payer: Networks By Design Commercial |
$309.05
|
| Rate for Payer: Prime Health Services Commercial |
$404.14
|
| Rate for Payer: Riverside University Health System MISP |
$190.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$285.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.73
|
| Rate for Payer: United Healthcare All Other HMO |
$237.73
|
| Rate for Payer: United Healthcare HMO Rider |
$237.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$404.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$404.14
|
| Rate for Payer: Vantage Medical Group Senior |
$404.14
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 6131423710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2.17
|
| Rate for Payer: Blue Shield of California EPN |
$1.36
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 6131423710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
| Rate for Payer: Riverside University Health System MISP |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
CROMOLYN 5.2 MG/SPRAY (4 %) NASAL SPRAY [24325]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 5778239726
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
CROMOLYN 5.2 MG/SPRAY (4 %) NASAL SPRAY [24325]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 5778239726
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
|
CROTALIDAE POLYVAL IMMUNE FAB 1 GRAM SOLUTION FOR INJECTION [29313]
|
Facility
|
OP
|
$3,837.60
|
|
|
Service Code
|
HCPCS J0840
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$767.52 |
| Max. Negotiated Rate |
$10,880.87 |
| Rate for Payer: Adventist Health Commercial |
$767.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,906.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,880.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,383.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,097.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,097.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,022.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,019.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4,221.36
|
| Rate for Payer: Blue Shield of California EPN |
$3,837.60
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Central Health Plan Commercial |
$3,070.08
|
| Rate for Payer: Cigna of CA HMO |
$2,686.32
|
| Rate for Payer: Cigna of CA PPO |
$2,686.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,383.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,097.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,097.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,686.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,146.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,097.60
|
| Rate for Payer: Galaxy Health WC |
$3,261.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2,302.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,453.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,127.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,906.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,906.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,436.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,470.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,669.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,555.26
|
| Rate for Payer: Multiplan Commercial |
$2,878.20
|
| Rate for Payer: Networks By Design Commercial |
$1,918.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,906.91
|
| Rate for Payer: Prime Health Services Commercial |
$3,261.96
|
| Rate for Payer: Prime Health Services Medicare |
$2,021.32
|
| Rate for Payer: Riverside University Health System MISP |
$2,097.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,302.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,302.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,440.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,401.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1,371.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,256.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,906.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,383.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,097.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,097.60
|
|
|
CROTALIDAE POLYVAL IMMUNE FAB 1 GRAM SOLUTION FOR INJECTION [29313]
|
Facility
|
IP
|
$3,837.60
|
|
|
Service Code
|
HCPCS J0840
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$767.52 |
| Max. Negotiated Rate |
$3,453.84 |
| Rate for Payer: Adventist Health Commercial |
$767.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3,077.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,934.15
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Central Health Plan Commercial |
$3,070.08
|
| Rate for Payer: Cigna of CA HMO |
$2,686.32
|
| Rate for Payer: Cigna of CA PPO |
$2,686.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,686.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,535.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1,535.04
|
| Rate for Payer: Galaxy Health WC |
$3,261.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2,302.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,453.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,436.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,264.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.52
|
| Rate for Payer: Multiplan Commercial |
$2,878.20
|
| Rate for Payer: Networks By Design Commercial |
$1,918.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,261.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,440.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,401.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1,371.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,256.81
|
|
|
CRYOSURGICAL ABLATION OF THE PROSTATE (INCLUDES ULTRASONIC GUIDANCE AND MONITORING)
|
Facility
|
OP
|
$50,447.00
|
|
|
Service Code
|
CPT 55873
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,315.83 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,175.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,263.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,393.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,175.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,720.61
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,263.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,393.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,175.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,089.49
|
| Rate for Payer: EPIC Health Plan Senior |
$13,393.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19,967.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,175.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,045.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,315.10
|
| Rate for Payer: Multiplan WC |
$18,720.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,175.45
|
| Rate for Payer: Preferred Health Network WC |
$19,102.66
|
| Rate for Payer: Prime Health Services Medicare |
$12,905.98
|
| Rate for Payer: Prime Health Services WC |
$18,529.58
|
| Rate for Payer: Riverside University Health System MISP |
$13,393.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$12,175.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,263.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,393.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,175.45
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
OP
|
$3.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Central Health Plan Commercial |
$2.08
|
| Rate for Payer: Central Health Plan Commercial |
$3.04
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$2.85
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Riverside University Health System MISP |
$1.52
|
| Rate for Payer: Riverside University Health System MISP |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO |
$1.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.23
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
IP
|
$3.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$3.04
|
| Rate for Payer: Central Health Plan Commercial |
$2.08
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$2.85
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$15,338.05
|
|
|
Service Code
|
APR-DRG 0452
|
| Min. Negotiated Rate |
$9,687.19 |
| Max. Negotiated Rate |
$15,338.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,687.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,543.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,338.05
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$12,425.54
|
|
|
Service Code
|
APR-DRG 0451
|
| Min. Negotiated Rate |
$7,847.71 |
| Max. Negotiated Rate |
$12,425.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,847.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,351.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,425.54
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$32,184.75
|
|
|
Service Code
|
APR-DRG 0454
|
| Min. Negotiated Rate |
$20,327.21 |
| Max. Negotiated Rate |
$32,184.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,327.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24,223.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32,184.75
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$20,526.61
|
|
|
Service Code
|
APR-DRG 0453
|
| Min. Negotiated Rate |
$12,964.18 |
| Max. Negotiated Rate |
$20,526.61 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,964.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,448.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,526.61
|
|
|
CVL-NICARDIPINE 20 MG/200 ML PREMIX FOR INTRA-ART/INTRA-CORONARY [4081031]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
|
|
CVL-NICARDIPINE 20 MG/200 ML PREMIX FOR INTRA-ART/INTRA-CORONARY [4081031]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
