|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| 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 |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.29
|
| 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
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.57
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.29
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
OP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.44 |
| Max. Negotiated Rate |
$303.82 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$250.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.08
|
| Rate for Payer: Blue Shield of California Commercial |
$32.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.44
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$186.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.56
|
| Rate for Payer: Heritage Provider Network Senior |
$187.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$193.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.85
|
| Rate for Payer: Multiplan Commercial |
$303.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$162.04
|
| Rate for Payer: TriValley Medical Group Senior |
$162.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$146.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Vantage Medical Group Senior |
$37.64
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
IP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$303.82 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$260.88
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$186.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.56
|
| Rate for Payer: Heritage Provider Network Senior |
$187.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.28
|
| Rate for Payer: Multiplan Commercial |
$303.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$146.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.13
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
OP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.44 |
| Max. Negotiated Rate |
$303.82 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$250.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.08
|
| Rate for Payer: Blue Shield of California Commercial |
$32.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.44
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$186.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.56
|
| Rate for Payer: Heritage Provider Network Senior |
$187.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$193.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.85
|
| Rate for Payer: Multiplan Commercial |
$303.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$162.04
|
| Rate for Payer: TriValley Medical Group Senior |
$162.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$146.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Vantage Medical Group Senior |
$37.64
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
IP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$303.82 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$260.88
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$186.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.56
|
| Rate for Payer: Heritage Provider Network Senior |
$187.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.28
|
| Rate for Payer: Multiplan Commercial |
$303.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$146.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.13
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
IP
|
$943.82
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.83 |
| Max. Negotiated Rate |
$707.87 |
| Rate for Payer: Adventist Health Commercial |
$188.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.82
|
| Rate for Payer: Cash Price |
$424.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$509.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$436.99
|
| Rate for Payer: Heritage Provider Network Senior |
$436.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.96
|
| Rate for Payer: Multiplan Commercial |
$707.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$341.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.50
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
OP
|
$943.82
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.83 |
| Max. Negotiated Rate |
$707.87 |
| Rate for Payer: Adventist Health Commercial |
$188.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.96
|
| Rate for Payer: Blue Shield of California Commercial |
$189.00
|
| Rate for Payer: Blue Shield of California EPN |
$189.00
|
| Rate for Payer: Cash Price |
$424.72
|
| Rate for Payer: Cash Price |
$424.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$205.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$436.99
|
| Rate for Payer: Heritage Provider Network Senior |
$436.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$205.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$450.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$275.38
|
| Rate for Payer: Multiplan Commercial |
$707.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$377.53
|
| Rate for Payer: TriValley Medical Group Senior |
$377.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$341.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.06
|
| Rate for Payer: Vantage Medical Group Senior |
$226.06
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
IP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$303.82 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$260.88
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$186.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.56
|
| Rate for Payer: Heritage Provider Network Senior |
$187.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.28
|
| Rate for Payer: Multiplan Commercial |
$303.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$146.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.13
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
OP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.44 |
| Max. Negotiated Rate |
$303.82 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$250.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.08
|
| Rate for Payer: Blue Shield of California Commercial |
$32.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.44
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$186.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.56
|
| Rate for Payer: Heritage Provider Network Senior |
$187.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$193.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.85
|
| Rate for Payer: Multiplan Commercial |
$303.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$162.04
|
| Rate for Payer: TriValley Medical Group Senior |
$162.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$146.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Vantage Medical Group Senior |
$37.64
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
IP
|
$540.38
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$405.29 |
| Rate for Payer: Adventist Health Commercial |
$108.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$348.00
|
| Rate for Payer: Cash Price |
$243.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$248.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.20
|
| Rate for Payer: Heritage Provider Network Senior |
$250.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.09
|
| Rate for Payer: Multiplan Commercial |
$405.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$195.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$178.92
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
OP
|
$540.38
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$2,001.38 |
| Rate for Payer: Adventist Health Commercial |
$108.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,001.38
|
| Rate for Payer: Blue Shield of California Commercial |
$193.94
|
| Rate for Payer: Blue Shield of California EPN |
$193.94
|
| Rate for Payer: Cash Price |
$243.17
|
| Rate for Payer: Cash Price |
$243.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$248.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.20
|
| Rate for Payer: Heritage Provider Network Senior |
$250.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$257.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$378.27
|
| Rate for Payer: Multiplan Commercial |
$405.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$216.15
|
| Rate for Payer: TriValley Medical Group Senior |
$216.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$195.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$178.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.32
|
| Rate for Payer: Vantage Medical Group Senior |
$459.32
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
|
IP
|
$35,940.85
|
|
|
Service Code
|
MSDRG 098
|
| Min. Negotiated Rate |
$26,821.53 |
| Max. Negotiated Rate |
$35,940.85 |
| Rate for Payer: EPIC Health Plan Medicare |
$26,821.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,821.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,844.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,940.85
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
|
IP
|
$56,162.48
|
|
|
Service Code
|
MSDRG 097
|
| Min. Negotiated Rate |
$41,912.30 |
| Max. Negotiated Rate |
$56,162.48 |
| Rate for Payer: EPIC Health Plan Medicare |
$41,912.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,912.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48,199.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56,162.48
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$21,621.89
|
|
|
Service Code
|
MSDRG 099
|
| Min. Negotiated Rate |
$16,135.74 |
| Max. Negotiated Rate |
$21,621.89 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,135.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,135.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,556.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,621.89
|
|
|
NON-EXTENSIVE BURNS
|
Facility
|
IP
|
$32,333.87
|
|
|
Service Code
|
MSDRG 935
|
| Min. Negotiated Rate |
$24,129.75 |
| Max. Negotiated Rate |
$32,333.87 |
| Rate for Payer: EPIC Health Plan Medicare |
$24,129.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,129.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,749.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,333.87
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$25,939.85
|
|
|
Service Code
|
MSDRG 988
|
| Min. Negotiated Rate |
$19,358.10 |
| Max. Negotiated Rate |
$25,939.85 |
| Rate for Payer: EPIC Health Plan Medicare |
$19,358.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,358.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,261.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,939.85
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$53,346.27
|
|
|
Service Code
|
MSDRG 987
|
| Min. Negotiated Rate |
$39,810.65 |
| Max. Negotiated Rate |
$53,346.27 |
| Rate for Payer: EPIC Health Plan Medicare |
$39,810.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39,810.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45,782.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53,346.27
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,115.88
|
|
|
Service Code
|
MSDRG 989
|
| Min. Negotiated Rate |
$14,265.58 |
| Max. Negotiated Rate |
$19,115.88 |
| Rate for Payer: EPIC Health Plan Medicare |
$14,265.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,265.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,405.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,115.88
|
|
|
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$16,695.85
|
|
|
Service Code
|
MSDRG 600
|
| Min. Negotiated Rate |
$12,459.59 |
| Max. Negotiated Rate |
$16,695.85 |
| Rate for Payer: EPIC Health Plan Medicare |
$12,459.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,459.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,328.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,695.85
|
|
|
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,991.67
|
|
|
Service Code
|
MSDRG 601
|
| Min. Negotiated Rate |
$7,456.47 |
| Max. Negotiated Rate |
$9,991.67 |
| Rate for Payer: EPIC Health Plan Medicare |
$7,456.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,456.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,574.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,991.67
|
|
|
NONTRAUMATIC STUPOR AND COMA WITH MCC
|
Facility
|
IP
|
$28,494.99
|
|
|
Service Code
|
MSDRG 080
|
| Min. Negotiated Rate |
$21,264.92 |
| Max. Negotiated Rate |
$28,494.99 |
| Rate for Payer: EPIC Health Plan Medicare |
$21,264.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,264.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,454.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,494.99
|
|
|
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC
|
Facility
|
IP
|
$14,453.95
|
|
|
Service Code
|
MSDRG 081
|
| Min. Negotiated Rate |
$10,786.53 |
| Max. Negotiated Rate |
$14,453.95 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,786.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,786.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,404.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,453.95
|
|
|
NOREPINEPHRINE 40 MCG/10 ML NS SYRINGE FOR ANESTHESIA [40805634]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
NOREPINEPHRINE 40 MCG/10 ML NS SYRINGE FOR ANESTHESIA [40805634]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
