|
CRANIECTOMY; WITH EXCISION OF TUMOR OR OTHER BONE LESION OF SKULL
|
Facility
|
OP
|
$14,160.00
|
|
|
Service Code
|
CPT 61500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$14,160.00 |
| 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: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$48,444.82
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$36,152.85 |
| Max. Negotiated Rate |
$48,444.82 |
| Rate for Payer: EPIC Health Plan Medicare |
$36,152.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,152.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41,575.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48,444.82
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$70,518.29
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$52,625.59 |
| Max. Negotiated Rate |
$70,518.29 |
| Rate for Payer: EPIC Health Plan Medicare |
$52,625.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$52,625.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60,519.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70,518.29
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$39,441.89
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$29,434.25 |
| Max. Negotiated Rate |
$39,441.89 |
| Rate for Payer: EPIC Health Plan Medicare |
$29,434.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,434.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,849.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39,441.89
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$104,060.78
|
|
|
Service Code
|
MSDRG 955
|
| Min. Negotiated Rate |
$77,657.30 |
| Max. Negotiated Rate |
$104,060.78 |
| Rate for Payer: EPIC Health Plan Medicare |
$77,657.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$77,657.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89,305.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104,060.78
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$88,693.03
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$66,188.83 |
| Max. Negotiated Rate |
$88,693.03 |
| Rate for Payer: EPIC Health Plan Medicare |
$66,188.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,188.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76,117.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$88,693.03
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$60,770.63
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$45,351.22 |
| Max. Negotiated Rate |
$60,770.63 |
| Rate for Payer: EPIC Health Plan Medicare |
$45,351.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$45,351.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52,153.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60,770.63
|
|
|
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT)
|
Facility
|
OP
|
$14,160.00
|
|
|
Service Code
|
CPT 36830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,245.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| 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 |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Senior |
$8,802.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,598.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,872.55
|
| Rate for Payer: TriValley Medical Group Senior |
$7,872.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
|
IP
|
$294.35
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$220.76 |
| Rate for Payer: Adventist Health Commercial |
$58.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$189.56
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$135.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.28
|
| Rate for Payer: Heritage Provider Network Senior |
$136.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.59
|
| Rate for Payer: Multiplan Commercial |
$220.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$106.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.46
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
|
OP
|
$294.35
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$287.85 |
| Rate for Payer: Adventist Health Commercial |
$58.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.85
|
| Rate for Payer: Blue Shield of California Commercial |
$125.10
|
| Rate for Payer: Blue Shield of California EPN |
$125.10
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$135.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$129.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.28
|
| Rate for Payer: Heritage Provider Network Senior |
$136.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$129.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$140.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174.12
|
| Rate for Payer: Multiplan Commercial |
$220.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$117.74
|
| Rate for Payer: TriValley Medical Group Senior |
$117.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$106.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.93
|
| Rate for Payer: Vantage Medical Group Senior |
$142.93
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
|
IP
|
$475.46
|
|
|
Service Code
|
NDC 0069814020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$356.60 |
| Rate for Payer: Adventist Health Commercial |
$95.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$306.20
|
| Rate for Payer: Cash Price |
$213.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$321.89
|
| Rate for Payer: Heritage Provider Network Senior |
$321.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.86
|
| Rate for Payer: Multiplan Commercial |
$356.60
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
|
OP
|
$475.46
|
|
|
Service Code
|
NDC 0069814020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$404.14 |
| Rate for Payer: Adventist Health Commercial |
$95.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$293.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$404.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$261.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$356.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.83
|
| Rate for Payer: Blue Shield of California Commercial |
$290.03
|
| Rate for Payer: Blue Shield of California EPN |
$232.02
|
| Rate for Payer: Cash Price |
$213.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$309.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$404.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$404.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$404.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.31
|
| Rate for Payer: Heritage Provider Network Senior |
$294.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$226.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$332.82
|
| Rate for Payer: Multiplan Commercial |
$356.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$190.18
|
| Rate for Payer: TriValley Medical Group Senior |
$190.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$237.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$237.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$404.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$404.14
|
| Rate for Payer: Vantage Medical Group Senior |
$404.14
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 6131423710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.74
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 6131423710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.67
|
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
CROMOLYN 5.2 MG/SPRAY (4 %) NASAL SPRAY [24325]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 5778239726
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
CROMOLYN 5.2 MG/SPRAY (4 %) NASAL SPRAY [24325]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 5778239726
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
|
|
CROTALIDAE POLYVAL IMMUNE FAB 1 GRAM SOLUTION FOR INJECTION [29313]
|
Facility
|
IP
|
$3,837.60
|
|
|
Service Code
|
HCPCS J0840
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$694.61 |
| Max. Negotiated Rate |
$2,878.20 |
| Rate for Payer: Adventist Health Commercial |
$767.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,471.41
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,765.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,072.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,776.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,776.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$694.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$959.40
|
| Rate for Payer: Multiplan Commercial |
$2,878.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,386.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,270.63
|
|
|
CROTALIDAE POLYVAL IMMUNE FAB 1 GRAM SOLUTION FOR INJECTION [29313]
|
Facility
|
OP
|
$3,837.60
|
|
|
Service Code
|
HCPCS J0840
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$694.61 |
| Max. Negotiated Rate |
$4,927.19 |
| Rate for Payer: Adventist Health Commercial |
$767.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,371.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,383.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,097.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,097.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,927.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,261.96
|
| Rate for Payer: Blue Shield of California EPN |
$3,261.96
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,765.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,383.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,097.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,097.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,456.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,906.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,776.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,776.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,906.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,830.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$694.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,192.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$959.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,555.26
|
| Rate for Payer: Multiplan Commercial |
$2,878.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,535.04
|
| Rate for Payer: TriValley Medical Group Senior |
$1,535.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,386.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,270.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,383.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,097.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,097.60
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
IP
|
$3.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.45
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$2.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.86
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
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: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.85
|
| 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 Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$2.85
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.52
|
| Rate for Payer: TriValley Medical Group Senior |
$1.04
|
| Rate for Payer: TriValley Medical Group Senior |
$1.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.23
|
| 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 Medi-Cal |
$3.23
|
| Rate for Payer: Vantage Medical Group Senior |
$3.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
CVL-NICARDIPINE 20 MG/200 ML PREMIX FOR INTRA-ART/INTRA-CORONARY [4081031]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
|
|
CVL-NICARDIPINE 20 MG/200 ML PREMIX FOR INTRA-ART/INTRA-CORONARY [4081031]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
CVL-VERAPAMIL 5MG/50ML NS FOR IA/IC BOLUS [4080934]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
CVL-VERAPAMIL 5MG/50ML NS FOR IA/IC BOLUS [4080934]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.52
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]
|
Facility
|
OP
|
$2.64
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$6.28 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.34
|
| Rate for Payer: Blue Shield of California Commercial |
$3.34
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Senior |
$1.06
|
| Rate for Payer: TriValley Medical Group Senior |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$2.24
|
|
