|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$150,921.05
|
|
|
Service Code
|
MSDRG 216
|
| Min. Negotiated Rate |
$28,410.00 |
| Max. Negotiated Rate |
$150,921.05 |
| Rate for Payer: EPIC Health Plan Medicare |
$112,627.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$112,627.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129,521.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$150,921.05
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$101,668.37
|
|
|
Service Code
|
MSDRG 218
|
| Min. Negotiated Rate |
$28,410.00 |
| Max. Negotiated Rate |
$101,668.37 |
| Rate for Payer: EPIC Health Plan Medicare |
$75,871.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75,871.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87,252.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101,668.37
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC
|
Facility
|
IP
|
$82,589.23
|
|
|
Service Code
|
MSDRG 220
|
| Min. Negotiated Rate |
$28,410.00 |
| Max. Negotiated Rate |
$82,589.23 |
| Rate for Payer: EPIC Health Plan Medicare |
$61,633.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61,633.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70,878.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$82,589.23
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$118,605.48
|
|
|
Service Code
|
MSDRG 219
|
| Min. Negotiated Rate |
$28,410.00 |
| Max. Negotiated Rate |
$118,605.48 |
| Rate for Payer: EPIC Health Plan Medicare |
$88,511.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88,511.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101,788.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$118,605.48
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$78,096.21
|
|
|
Service Code
|
MSDRG 221
|
| Min. Negotiated Rate |
$28,410.00 |
| Max. Negotiated Rate |
$78,096.21 |
| Rate for Payer: EPIC Health Plan Medicare |
$58,280.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,280.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67,022.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78,096.21
|
|
|
CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]
|
Facility
|
OP
|
$756.96
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$567.72 |
| Rate for Payer: Adventist Health Commercial |
$151.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$467.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.93
|
| Rate for Payer: Blue Shield of California Commercial |
$55.67
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$340.63
|
| Rate for Payer: Cash Price |
$340.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$348.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$350.47
|
| Rate for Payer: Heritage Provider Network Senior |
$350.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$361.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.79
|
| Rate for Payer: Multiplan Commercial |
$567.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$302.78
|
| Rate for Payer: TriValley Medical Group Senior |
$302.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$273.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$250.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Vantage Medical Group Senior |
$66.32
|
|
|
CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]
|
Facility
|
IP
|
$756.96
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.01 |
| Max. Negotiated Rate |
$567.72 |
| Rate for Payer: Adventist Health Commercial |
$151.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$487.48
|
| Rate for Payer: Cash Price |
$340.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$348.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$350.47
|
| Rate for Payer: Heritage Provider Network Senior |
$350.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.24
|
| Rate for Payer: Multiplan Commercial |
$567.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$273.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$250.63
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]
|
Facility
|
IP
|
$2,270.88
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$411.03 |
| Max. Negotiated Rate |
$1,703.16 |
| Rate for Payer: Adventist Health Commercial |
$454.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,462.45
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,044.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,226.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,051.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,051.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$411.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.72
|
| Rate for Payer: Multiplan Commercial |
$1,703.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$820.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$751.89
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]
|
Facility
|
OP
|
$2,270.88
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$1,703.16 |
| Rate for Payer: Adventist Health Commercial |
$454.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,403.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.93
|
| Rate for Payer: Blue Shield of California Commercial |
$55.67
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,044.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,453.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,051.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,051.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,083.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$411.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.79
|
| Rate for Payer: Multiplan Commercial |
$1,703.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$908.35
|
| Rate for Payer: TriValley Medical Group Senior |
$908.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$820.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$751.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Vantage Medical Group Senior |
$66.32
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]
|
Facility
|
IP
|
$4,541.75
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$822.06 |
| Max. Negotiated Rate |
$3,406.31 |
| Rate for Payer: Adventist Health Commercial |
$908.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,924.89
|
| Rate for Payer: Cash Price |
$2,043.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,089.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,452.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,102.83
|
| Rate for Payer: Heritage Provider Network Senior |
$2,102.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$822.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.44
|
| Rate for Payer: Multiplan Commercial |
$3,406.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,640.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,503.77
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]
|
Facility
|
OP
|
$4,541.75
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$3,406.31 |
| Rate for Payer: Adventist Health Commercial |
$908.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,806.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.93
|
| Rate for Payer: Blue Shield of California Commercial |
$55.67
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$2,043.79
|
| Rate for Payer: Cash Price |
$2,043.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,089.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,906.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,102.83
|
| Rate for Payer: Heritage Provider Network Senior |
$2,102.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,166.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$822.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.79
|
| Rate for Payer: Multiplan Commercial |
$3,406.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,816.70
|
| Rate for Payer: TriValley Medical Group Senior |
$1,816.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,640.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,503.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Vantage Medical Group Senior |
$66.32
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 5022810901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.07
|
| 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 |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 6958411110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 6958411110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 5022810901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| 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 |
$0.11
|
|
|
CARMUSTINE 100 MG INTRAVENOUS POWDER FOR SOLUTION [28911]
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.29 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Adventist Health Commercial |
$84.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$260.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$400.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$360.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$360.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.72
|
| Rate for Payer: Blue Shield of California Commercial |
$765.00
|
| Rate for Payer: Blue Shield of California Commercial |
$765.00
|
| Rate for Payer: Blue Shield of California EPN |
$765.00
|
| Rate for Payer: Blue Shield of California EPN |
$765.00
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$298.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$240.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$240.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.02
|
| Rate for Payer: Heritage Provider Network Senior |
$300.02
|
| Rate for Payer: Heritage Provider Network Senior |
$195.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$240.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$240.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$309.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$200.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$321.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$321.61
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$315.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$168.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$259.20
|
| Rate for Payer: TriValley Medical Group Senior |
$168.48
|
| Rate for Payer: TriValley Medical Group Senior |
$259.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$234.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$152.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$214.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$139.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Vantage Medical Group Senior |
$264.01
|
| Rate for Payer: Vantage Medical Group Senior |
$264.01
|
|
|
CARMUSTINE 100 MG INTRAVENOUS POWDER FOR SOLUTION [28911]
|
Facility
|
IP
|
$421.20
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.24 |
| Max. Negotiated Rate |
$315.90 |
| Rate for Payer: Adventist Health Commercial |
$84.24
|
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$271.25
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$298.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$349.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.02
|
| Rate for Payer: Heritage Provider Network Senior |
$300.02
|
| Rate for Payer: Heritage Provider Network Senior |
$195.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$315.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$152.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$234.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$214.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$139.46
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
|
IP
|
$37,408.83
|
|
|
Service Code
|
MSDRG 035
|
| Min. Negotiated Rate |
$14,752.00 |
| Max. Negotiated Rate |
$37,408.83 |
| Rate for Payer: EPIC Health Plan Medicare |
$27,917.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,917.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,104.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37,408.83
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$60,137.99
|
|
|
Service Code
|
MSDRG 034
|
| Min. Negotiated Rate |
$14,752.00 |
| Max. Negotiated Rate |
$60,137.99 |
| Rate for Payer: EPIC Health Plan Medicare |
$44,879.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44,879.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51,610.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60,137.99
|
|
|
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,534.19
|
|
|
Service Code
|
MSDRG 036
|
| Min. Negotiated Rate |
$14,752.00 |
| Max. Negotiated Rate |
$30,534.19 |
| Rate for Payer: EPIC Health Plan Medicare |
$22,786.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,786.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,204.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,534.19
|
|
|
CARTILAGE GRAFT; NASAL SEPTUM
|
Facility
|
OP
|
$10,001.00
|
|
|
Service Code
|
CPT 20912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,557.82 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,557.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,013.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,557.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,557.82
|
| Rate for Payer: Heritage Provider Network Senior |
$5,606.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,659.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,241.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,107.48
|
| Rate for Payer: Multiplan WC |
$7,411.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,013.60
|
| Rate for Payer: TriValley Medical Group Senior |
$5,013.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,557.82
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 6838209401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0093729501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 6800115100
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0904630261
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
