|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0600053772
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0600053772
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| 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 |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0600053797
|
| 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
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0600053797
|
| 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
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML)SUBCUTANEOUS. [4081378]
|
Facility
|
OP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$5,669.46 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,671.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.24
|
| Rate for Payer: Blue Shield of California Commercial |
$14.59
|
| Rate for Payer: Blue Shield of California EPN |
$14.59
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,477.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,837.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,499.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,499.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,605.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,368.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,889.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$5,669.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,023.71
|
| Rate for Payer: TriValley Medical Group Senior |
$3,023.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,502.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3.78
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML)SUBCUTANEOUS. [4081378]
|
Facility
|
IP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,368.23 |
| Max. Negotiated Rate |
$5,669.46 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,868.18
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,477.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,082.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,499.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,499.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,368.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,889.82
|
| Rate for Payer: Multiplan Commercial |
$5,669.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,502.88
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X2) SUBCUTANEOUS SYRINGE KIT [97853]
|
Facility
|
OP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$5,669.46 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,671.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.24
|
| Rate for Payer: Blue Shield of California Commercial |
$14.59
|
| Rate for Payer: Blue Shield of California EPN |
$14.59
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,477.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,837.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,499.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,499.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,605.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,368.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,889.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$5,669.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,023.71
|
| Rate for Payer: TriValley Medical Group Senior |
$3,023.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,502.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3.78
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X2) SUBCUTANEOUS SYRINGE KIT [97853]
|
Facility
|
IP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,368.23 |
| Max. Negotiated Rate |
$5,669.46 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,868.18
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,477.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,082.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,499.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,499.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,368.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,889.82
|
| Rate for Payer: Multiplan Commercial |
$5,669.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,502.88
|
|
|
CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION)
|
Facility
|
OP
|
$12,185.00
|
|
|
Service Code
|
CPT 38724
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,273.00 |
| Max. Negotiated Rate |
$12,185.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| 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: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$45,940.32
|
|
|
Service Code
|
MSDRG 472
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$45,940.32 |
| Rate for Payer: EPIC Health Plan Medicare |
$34,283.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,283.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39,426.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,940.32
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$74,848.54
|
|
|
Service Code
|
MSDRG 471
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$74,848.54 |
| Rate for Payer: EPIC Health Plan Medicare |
$55,857.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,857.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64,235.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74,848.54
|
|
|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$38,188.89
|
|
|
Service Code
|
MSDRG 473
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$38,188.89 |
| Rate for Payer: EPIC Health Plan Medicare |
$28,499.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,499.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,774.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,188.89
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$17,850.54
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$7,879.00 |
| Max. Negotiated Rate |
$17,850.54 |
| Rate for Payer: EPIC Health Plan Medicare |
$13,321.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,663.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,879.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,321.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,453.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,319.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,850.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,088.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,167.00
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$26,030.44
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$7,879.00 |
| Max. Negotiated Rate |
$26,030.44 |
| Rate for Payer: EPIC Health Plan Medicare |
$19,425.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,663.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,879.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,425.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,453.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,339.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,030.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,088.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,167.00
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$15,424.43
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$7,879.00 |
| Max. Negotiated Rate |
$15,424.43 |
| Rate for Payer: EPIC Health Plan Medicare |
$11,510.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,663.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,879.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,510.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,453.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,237.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,424.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,088.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,167.00
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$16,979.90
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$7,879.00 |
| Max. Negotiated Rate |
$16,979.90 |
| Rate for Payer: EPIC Health Plan Medicare |
$12,671.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,663.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,879.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,671.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,453.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,572.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,979.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,088.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,167.00
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$38,400.81
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$7,879.00 |
| Max. Negotiated Rate |
$38,400.81 |
| Rate for Payer: EPIC Health Plan Medicare |
$28,657.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,663.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,879.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,657.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,453.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,955.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,400.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,088.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,167.00
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$15,409.06
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$7,879.00 |
| Max. Negotiated Rate |
$15,409.06 |
| Rate for Payer: EPIC Health Plan Medicare |
$11,499.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,663.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,879.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,499.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,453.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,224.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,409.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,088.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,167.00
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 4580297426
|
| 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
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 4580297426
|
| 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
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.30
|
| Rate for Payer: Blue Shield of California Commercial |
$82.02
|
| Rate for Payer: Blue Shield of California EPN |
$82.02
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$81.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.44
|
| Rate for Payer: Heritage Provider Network Senior |
$9.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$81.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.44
|
| Rate for Payer: Multiplan Commercial |
$15.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.15
|
| Rate for Payer: TriValley Medical Group Senior |
$8.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Vantage Medical Group Senior |
$89.84
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$15.29 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.12
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.44
|
| Rate for Payer: Heritage Provider Network Senior |
$9.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$15.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.75
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$15.29 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.12
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.44
|
| Rate for Payer: Heritage Provider Network Senior |
$9.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$15.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.75
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.30
|
| Rate for Payer: Blue Shield of California Commercial |
$82.02
|
| Rate for Payer: Blue Shield of California EPN |
$82.02
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$81.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.44
|
| Rate for Payer: Heritage Provider Network Senior |
$9.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$81.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.44
|
| Rate for Payer: Multiplan Commercial |
$15.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.15
|
| Rate for Payer: TriValley Medical Group Senior |
$8.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Vantage Medical Group Senior |
$89.84
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (IE, PROUD FLESH)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 17250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Senior |
$317.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$490.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$283.86
|
| Rate for Payer: TriValley Medical Group Senior |
$283.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
