|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$34,357.72
|
|
|
Service Code
|
MSDRG 614
|
| Min. Negotiated Rate |
$25,640.09 |
| Max. Negotiated Rate |
$34,357.72 |
| Rate for Payer: EPIC Health Plan Medicare |
$25,640.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,640.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,486.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34,357.72
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,188.51
|
|
|
Service Code
|
MSDRG 615
|
| Min. Negotiated Rate |
$16,558.59 |
| Max. Negotiated Rate |
$22,188.51 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,558.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,558.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,042.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,188.51
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [152966]
|
Facility
|
OP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$743.61 |
| Max. Negotiated Rate |
$36,010.80 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,672.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$817.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,242.29
|
| Rate for Payer: Blue Shield of California Commercial |
$943.50
|
| Rate for Payer: Blue Shield of California EPN |
$943.50
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,086.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$817.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$817.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,729.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$743.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,230.67
|
| Rate for Payer: Heritage Provider Network Senior |
$22,230.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$743.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$22,902.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,690.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$855.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,003.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$996.44
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$19,205.76
|
| Rate for Payer: TriValley Medical Group Senior |
$19,205.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,347.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,897.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Vantage Medical Group Senior |
$817.97
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [152966]
|
Facility
|
IP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,690.61 |
| Max. Negotiated Rate |
$36,010.80 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30,921.27
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,086.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,927.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,230.67
|
| Rate for Payer: Heritage Provider Network Senior |
$22,230.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,690.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,003.60
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,347.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,897.57
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SYRINGE [226632]
|
Facility
|
IP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,690.61 |
| Max. Negotiated Rate |
$36,010.80 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30,921.27
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,086.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,927.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,230.67
|
| Rate for Payer: Heritage Provider Network Senior |
$22,230.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,690.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,003.60
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,347.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,897.57
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SYRINGE [226632]
|
Facility
|
OP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$743.61 |
| Max. Negotiated Rate |
$36,010.80 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,672.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$817.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,242.29
|
| Rate for Payer: Blue Shield of California Commercial |
$943.50
|
| Rate for Payer: Blue Shield of California EPN |
$943.50
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,086.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$817.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$817.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,729.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$743.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,230.67
|
| Rate for Payer: Heritage Provider Network Senior |
$22,230.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$743.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$22,902.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,690.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$855.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,003.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$996.44
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$19,205.76
|
| Rate for Payer: TriValley Medical Group Senior |
$19,205.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,347.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,897.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Vantage Medical Group Senior |
$817.97
|
|
|
AFLIBERCEPT 8 MG/0.07 ML INTRAVITREAL SOLUTION FOR INJECTION [239224]
|
Facility
|
IP
|
$48,222.51
|
|
|
Service Code
|
HCPCS J0177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,728.27 |
| Max. Negotiated Rate |
$36,166.88 |
| Rate for Payer: Adventist Health Commercial |
$9,644.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,055.30
|
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,182.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,040.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,327.02
|
| Rate for Payer: Heritage Provider Network Senior |
$22,327.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,728.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,055.63
|
| Rate for Payer: Multiplan Commercial |
$36,166.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,422.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,966.47
|
|
|
AFLIBERCEPT 8 MG/0.07 ML INTRAVITREAL SOLUTION FOR INJECTION [239224]
|
Facility
|
OP
|
$48,222.51
|
|
|
Service Code
|
HCPCS J0177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$298.68 |
| Max. Negotiated Rate |
$36,166.88 |
| Rate for Payer: EPIC Health Plan Medicare |
$298.68
|
| Rate for Payer: Adventist Health Commercial |
$9,644.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,801.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$328.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.51
|
| Rate for Payer: Blue Shield of California Commercial |
$334.69
|
| Rate for Payer: Blue Shield of California EPN |
$334.69
|
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,182.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$328.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$328.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,862.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,327.02
|
| Rate for Payer: Heritage Provider Network Senior |
$22,327.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$298.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23,002.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,728.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$343.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,055.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$400.23
|
| Rate for Payer: Multiplan Commercial |
$36,166.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$19,289.00
|
| Rate for Payer: TriValley Medical Group Senior |
$19,289.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,422.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,966.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$328.55
|
| Rate for Payer: Vantage Medical Group Senior |
$328.55
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$17,993.37
|
|
|
Service Code
|
MSDRG 560
|
| Min. Negotiated Rate |
$13,427.89 |
| Max. Negotiated Rate |
$17,993.37 |
| Rate for Payer: EPIC Health Plan Medicare |
$13,427.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,427.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,442.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,993.37
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$29,338.00
|
|
|
Service Code
|
MSDRG 559
|
| Min. Negotiated Rate |
$21,894.03 |
| Max. Negotiated Rate |
$29,338.00 |
| Rate for Payer: EPIC Health Plan Medicare |
$21,894.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,894.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25,178.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,338.00
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$13,045.85
|
|
|
Service Code
|
MSDRG 561
|
| Min. Negotiated Rate |
$9,735.71 |
| Max. Negotiated Rate |
$13,045.85 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,735.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,735.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,196.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,045.85
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
|
IP
|
$18,969.98
|
|
|
Service Code
|
MSDRG 949
|
| Min. Negotiated Rate |
$14,156.70 |
| Max. Negotiated Rate |
$18,969.98 |
| Rate for Payer: EPIC Health Plan Medicare |
$14,156.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,156.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,280.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,969.98
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
|
IP
|
$10,340.22
|
|
|
Service Code
|
MSDRG 950
|
| Min. Negotiated Rate |
$7,716.58 |
| Max. Negotiated Rate |
$10,340.22 |
| Rate for Payer: EPIC Health Plan Medicare |
$7,716.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,716.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,874.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,340.22
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION [35775]
|
Facility
|
IP
|
$9,674.75
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,751.13 |
| Max. Negotiated Rate |
$7,256.06 |
| Rate for Payer: Adventist Health Commercial |
$1,934.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,230.54
|
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,450.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,224.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,479.41
|
| Rate for Payer: Heritage Provider Network Senior |
$4,479.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,751.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,418.69
|
| Rate for Payer: Multiplan Commercial |
$7,256.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,495.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,203.31
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION [35775]
|
Facility
|
OP
|
$9,674.75
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.22 |
| Max. Negotiated Rate |
$7,256.06 |
| Rate for Payer: Adventist Health Commercial |
$1,934.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,979.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.48
|
| Rate for Payer: Blue Shield of California Commercial |
$217.22
|
| Rate for Payer: Blue Shield of California EPN |
$217.22
|
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,450.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,191.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$232.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,479.41
|
| Rate for Payer: Heritage Provider Network Senior |
$4,479.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$232.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,614.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,751.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,418.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$7,256.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,869.90
|
| Rate for Payer: TriValley Medical Group Senior |
$3,869.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,495.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,203.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Vantage Medical Group Senior |
$255.99
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION [38494]
|
Facility
|
IP
|
$1,381.87
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$250.12 |
| Max. Negotiated Rate |
$1,036.40 |
| Rate for Payer: Adventist Health Commercial |
$276.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$889.92
|
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$635.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$746.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$639.81
|
| Rate for Payer: Heritage Provider Network Senior |
$639.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$250.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.47
|
| Rate for Payer: Multiplan Commercial |
$1,036.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$499.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$457.54
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION [38494]
|
Facility
|
OP
|
$1,381.87
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.22 |
| Max. Negotiated Rate |
$1,036.40 |
| Rate for Payer: Adventist Health Commercial |
$276.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$854.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.48
|
| Rate for Payer: Blue Shield of California Commercial |
$217.22
|
| Rate for Payer: Blue Shield of California EPN |
$217.22
|
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$635.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$232.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$639.81
|
| Rate for Payer: Heritage Provider Network Senior |
$639.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$232.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$659.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$250.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$1,036.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$552.75
|
| Rate for Payer: TriValley Medical Group Senior |
$552.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$499.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$457.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Vantage Medical Group Senior |
$255.99
|
|
|
AGAR (BULK) 100 % POWDER [40822641]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 9999922641
|
| 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 Non-Gatekeeper |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
AGAR (BULK) 100 % POWDER [40822641]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 9999922641
|
| 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 Non-Gatekeeper |
$0.11
|
| 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 |
$0.13
|
| 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 |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/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: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| 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
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
|
IP
|
$70,759.37
|
|
|
Service Code
|
MSDRG 245
|
| Min. Negotiated Rate |
$10,312.00 |
| Max. Negotiated Rate |
$70,759.37 |
| Rate for Payer: EPIC Health Plan Medicare |
$52,805.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,338.00
|
| Rate for Payer: Heritage Provider Network Senior |
$10,312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$52,805.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60,726.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70,759.37
|
|
|
AICD LEAD PROCEDURES
|
Facility
|
IP
|
$56,260.74
|
|
|
Service Code
|
MSDRG 265
|
| Min. Negotiated Rate |
$10,312.00 |
| Max. Negotiated Rate |
$56,260.74 |
| Rate for Payer: EPIC Health Plan Medicare |
$41,985.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,338.00
|
| Rate for Payer: Heritage Provider Network Senior |
$10,312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,985.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48,283.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56,260.74
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
OP
|
$35.85
|
|
|
Service Code
|
NDC 7220505108
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$30.47 |
| Rate for Payer: Adventist Health Commercial |
$7.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.93
|
| Rate for Payer: Blue Shield of California Commercial |
$21.87
|
| Rate for Payer: Blue Shield of California EPN |
$17.49
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.19
|
| Rate for Payer: Heritage Provider Network Senior |
$22.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.09
|
| Rate for Payer: Multiplan Commercial |
$26.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.34
|
| Rate for Payer: TriValley Medical Group Senior |
$14.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.47
|
| Rate for Payer: Vantage Medical Group Senior |
$30.47
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
OP
|
$21.49
|
|
|
Service Code
|
NDC 4359845202
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.75
|
| Rate for Payer: Blue Shield of California Commercial |
$13.11
|
| Rate for Payer: Blue Shield of California EPN |
$10.49
|
| Rate for Payer: Cash Price |
$9.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.30
|
| Rate for Payer: Heritage Provider Network Senior |
$13.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.04
|
| Rate for Payer: Multiplan Commercial |
$16.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.60
|
| Rate for Payer: TriValley Medical Group Senior |
$8.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.27
|
| Rate for Payer: Vantage Medical Group Senior |
$18.27
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
NDC 3172293502
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.18
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.37
|
| Rate for Payer: Heritage Provider Network Senior |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
IP
|
$21.49
|
|
|
Service Code
|
NDC 4359845202
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$16.12 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.84
|
| Rate for Payer: Cash Price |
$9.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.55
|
| Rate for Payer: Heritage Provider Network Senior |
$14.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.37
|
| Rate for Payer: Multiplan Commercial |
$16.12
|
|
