|
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
|
Facility
|
IP
|
$167,678.47
|
|
|
Service Code
|
MSDRG 212
|
| Min. Negotiated Rate |
$125,133.19 |
| Max. Negotiated Rate |
$167,678.47 |
| Rate for Payer: EPIC Health Plan Medicare |
$125,133.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125,133.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143,903.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$167,678.47
|
|
|
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION
|
Facility
|
IP
|
$103,375.93
|
|
|
Service Code
|
MSDRG 317
|
| Min. Negotiated Rate |
$77,146.22 |
| Max. Negotiated Rate |
$103,375.93 |
| Rate for Payer: EPIC Health Plan Medicare |
$77,146.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$77,146.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,718.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$103,375.93
|
|
|
CONCUSSION WITH CC
|
Facility
|
IP
|
$17,571.10
|
|
|
Service Code
|
MSDRG 089
|
| Min. Negotiated Rate |
$13,112.76 |
| Max. Negotiated Rate |
$17,571.10 |
| Rate for Payer: EPIC Health Plan Medicare |
$13,112.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,112.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,079.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,571.10
|
|
|
CONCUSSION WITH MCC
|
Facility
|
IP
|
$21,459.12
|
|
|
Service Code
|
MSDRG 088
|
| Min. Negotiated Rate |
$16,014.27 |
| Max. Negotiated Rate |
$21,459.12 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,014.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,014.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,416.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,459.12
|
|
|
CONCUSSION WITHOUT CC/MCC
|
Facility
|
IP
|
$13,342.22
|
|
|
Service Code
|
MSDRG 090
|
| Min. Negotiated Rate |
$9,956.88 |
| Max. Negotiated Rate |
$13,342.22 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,956.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,956.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,450.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,342.22
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 57520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,163.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Senior |
$5,121.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,910.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,579.83
|
| Rate for Payer: TriValley Medical Group Senior |
$4,579.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,163.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Senior |
$5,121.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,910.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,579.83
|
| Rate for Payer: TriValley Medical Group Senior |
$4,579.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET [9973]
|
Facility
|
IP
|
$8.72
|
|
|
Service Code
|
NDC 0046110081
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$6.54 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.62
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.90
|
| Rate for Payer: Heritage Provider Network Senior |
$5.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET [9973]
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
NDC 0046110081
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.36
|
| Rate for Payer: Blue Shield of California Commercial |
$5.32
|
| Rate for Payer: Blue Shield of California EPN |
$4.26
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.40
|
| Rate for Payer: Heritage Provider Network Senior |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.49
|
| Rate for Payer: TriValley Medical Group Senior |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.41
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [9977]
|
Facility
|
IP
|
$18.93
|
|
|
Service Code
|
NDC 0046087221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$14.20 |
| Rate for Payer: Adventist Health Commercial |
$3.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.19
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.82
|
| Rate for Payer: Heritage Provider Network Senior |
$12.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.73
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [9977]
|
Facility
|
OP
|
$18.93
|
|
|
Service Code
|
NDC 0046087221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Adventist Health Commercial |
$3.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.47
|
| Rate for Payer: Blue Shield of California Commercial |
$11.55
|
| Rate for Payer: Blue Shield of California EPN |
$9.24
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.72
|
| Rate for Payer: Heritage Provider Network Senior |
$11.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.57
|
| Rate for Payer: TriValley Medical Group Senior |
$7.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.09
|
| Rate for Payer: Vantage Medical Group Senior |
$16.09
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET [9974]
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
NDC 0046110281
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.36
|
| Rate for Payer: Blue Shield of California Commercial |
$5.32
|
| Rate for Payer: Blue Shield of California EPN |
$4.26
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.40
|
| Rate for Payer: Heritage Provider Network Senior |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.49
|
| Rate for Payer: TriValley Medical Group Senior |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.41
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET [9974]
|
Facility
|
IP
|
$8.72
|
|
|
Service Code
|
NDC 0046110281
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$6.54 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.62
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.90
|
| Rate for Payer: Heritage Provider Network Senior |
$5.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]
|
Facility
|
OP
|
$464.47
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.07 |
| Max. Negotiated Rate |
$538.01 |
| Rate for Payer: Adventist Health Commercial |
$92.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$287.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$501.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$441.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$441.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.83
|
| Rate for Payer: Blue Shield of California Commercial |
$375.41
|
| Rate for Payer: Blue Shield of California EPN |
$375.41
|
| Rate for Payer: Cash Price |
$209.01
|
| Rate for Payer: Cash Price |
$209.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$213.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$501.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$441.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$441.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$401.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.05
|
| Rate for Payer: Heritage Provider Network Senior |
$215.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$401.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$221.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$461.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$538.01
|
| Rate for Payer: Multiplan Commercial |
$348.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.79
|
| Rate for Payer: TriValley Medical Group Senior |
$185.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$167.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$153.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$501.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$441.65
|
| Rate for Payer: Vantage Medical Group Senior |
$441.65
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]
|
Facility
|
IP
|
$464.47
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.07 |
| Max. Negotiated Rate |
$348.35 |
| Rate for Payer: Adventist Health Commercial |
$92.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$299.12
|
| Rate for Payer: Cash Price |
$209.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$213.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.05
|
| Rate for Payer: Heritage Provider Network Senior |
$215.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.12
|
| Rate for Payer: Multiplan Commercial |
$348.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$167.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$153.79
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$18,412.58
|
|
|
Service Code
|
MSDRG 546
|
| Min. Negotiated Rate |
$13,740.73 |
| Max. Negotiated Rate |
$18,412.58 |
| Rate for Payer: EPIC Health Plan Medicare |
$13,740.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,740.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,801.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,412.58
|
|
|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$38,809.27
|
|
|
Service Code
|
MSDRG 545
|
| Min. Negotiated Rate |
$28,962.14 |
| Max. Negotiated Rate |
$38,809.27 |
| Rate for Payer: EPIC Health Plan Medicare |
$28,962.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,962.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,306.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,809.27
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$13,541.84
|
|
|
Service Code
|
MSDRG 547
|
| Min. Negotiated Rate |
$10,105.85 |
| Max. Negotiated Rate |
$13,541.84 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,105.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,105.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,621.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,541.84
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION [219718]
|
Facility
|
OP
|
$6,304.32
|
|
|
Service Code
|
HCPCS J9057
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.31 |
| Max. Negotiated Rate |
$5,358.67 |
| Rate for Payer: Adventist Health Commercial |
$1,260.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,896.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,358.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,467.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,728.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.78
|
| Rate for Payer: Blue Shield of California Commercial |
$89.31
|
| Rate for Payer: Blue Shield of California EPN |
$89.31
|
| Rate for Payer: Cash Price |
$2,836.94
|
| Rate for Payer: Cash Price |
$2,836.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,899.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,358.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,358.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,358.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,034.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,918.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,918.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,007.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,141.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,413.02
|
| Rate for Payer: Multiplan Commercial |
$4,728.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,521.73
|
| Rate for Payer: TriValley Medical Group Senior |
$2,521.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,277.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,087.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,358.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,358.67
|
| Rate for Payer: Vantage Medical Group Senior |
$5,358.67
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION [219718]
|
Facility
|
IP
|
$6,304.32
|
|
|
Service Code
|
HCPCS J9057
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,141.08 |
| Max. Negotiated Rate |
$4,728.24 |
| Rate for Payer: Adventist Health Commercial |
$1,260.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,059.98
|
| Rate for Payer: Cash Price |
$2,836.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,899.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,404.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,918.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,918.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,141.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.08
|
| Rate for Payer: Multiplan Commercial |
$4,728.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,277.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,087.36
|
|
|
COPPER 2 MG (AS GLUCONATE) TABLET [112194]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0536143901
|
| 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
|
|
|
COPPER 2 MG (AS GLUCONATE) TABLET [112194]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0536143901
|
| 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
|
|
|
COPPER CHLORIDE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080425]
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
COPPER CHLORIDE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080425]
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.67
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.86
|
|
|
COPPER SULFATE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080426]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 9994080426
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
|
