|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
OP
|
$92.05
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
NDG8259
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$78.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.93
|
| Rate for Payer: BCBS Transplant Transplant |
$55.23
|
| Rate for Payer: Blue Shield of California Commercial |
$59.46
|
| Rate for Payer: Blue Shield of California EPN |
$47.13
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cigna of CA HMO |
$58.91
|
| Rate for Payer: Cigna of CA PPO |
$68.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Media |
$37.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$78.24
|
| Rate for Payer: Global Benefits Group Commercial |
$55.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$69.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.01
|
| Rate for Payer: Heritage Provider Network Transplant |
$61.01
|
| Rate for Payer: IEHP Medi-Cal |
$60.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$60.26
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$73.64
|
| Rate for Payer: Networks By Design Commercial |
$59.83
|
| Rate for Payer: Prime Health Services Commercial |
$78.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$55.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
IP
|
$113.05
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
NDG2224
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.13 |
| Max. Negotiated Rate |
$96.09 |
| Rate for Payer: Cash Price |
$50.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.22
|
| Rate for Payer: Galaxy Health WC |
$96.09
|
| Rate for Payer: Global Benefits Group Commercial |
$67.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.13
|
| Rate for Payer: Multiplan Commercial |
$90.44
|
| Rate for Payer: Networks By Design Commercial |
$73.48
|
| Rate for Payer: Prime Health Services Commercial |
$96.09
|
|
|
TUCATINIB 150 MG TABLET [227737]
|
Facility
OP
|
$235.14
|
|
|
Service Code
|
NDC 51144-002-12
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$199.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$199.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$129.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$129.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.10
|
| Rate for Payer: BCBS Transplant Transplant |
$141.08
|
| Rate for Payer: Blue Shield of California Commercial |
$173.30
|
| Rate for Payer: Blue Shield of California EPN |
$137.32
|
| Rate for Payer: Cash Price |
$105.81
|
| Rate for Payer: Cigna of CA HMO |
$164.60
|
| Rate for Payer: Cigna of CA PPO |
$164.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.87
|
| Rate for Payer: Dignity Health Media |
$199.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$94.06
|
| Rate for Payer: Galaxy Health WC |
$199.87
|
| Rate for Payer: Global Benefits Group Commercial |
$141.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$176.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.43
|
| Rate for Payer: Multiplan Commercial |
$188.11
|
| Rate for Payer: Networks By Design Commercial |
$152.84
|
| Rate for Payer: Prime Health Services Commercial |
$199.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$141.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.57
|
| Rate for Payer: United Healthcare All Other HMO |
$117.57
|
| Rate for Payer: United Healthcare HMO Rider |
$117.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.87
|
| Rate for Payer: Vantage Medical Group Senior |
$199.87
|
|
|
TUCATINIB 150 MG TABLET [227737]
|
Facility
IP
|
$235.14
|
|
|
Service Code
|
NDC 51144-002-12
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$199.87 |
| Rate for Payer: Blue Shield of California Commercial |
$167.42
|
| Rate for Payer: Blue Shield of California EPN |
$120.39
|
| Rate for Payer: Cash Price |
$105.81
|
| Rate for Payer: Cigna of CA HMO |
$164.60
|
| Rate for Payer: Cigna of CA PPO |
$164.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.06
|
| Rate for Payer: Galaxy Health WC |
$199.87
|
| Rate for Payer: Global Benefits Group Commercial |
$141.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.43
|
| Rate for Payer: Multiplan Commercial |
$188.11
|
| Rate for Payer: Networks By Design Commercial |
$152.84
|
| Rate for Payer: Prime Health Services Commercial |
$199.87
|
|
|
TUCATINIB 50 MG TABLET [227736]
|
Facility
OP
|
$116.94
|
|
|
Service Code
|
NDC 51144-001-60
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$99.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.67
|
| Rate for Payer: BCBS Transplant Transplant |
$70.16
|
| Rate for Payer: Blue Shield of California Commercial |
$86.18
|
| Rate for Payer: Blue Shield of California EPN |
$68.29
|
| Rate for Payer: Cash Price |
$52.62
|
| Rate for Payer: Cigna of CA HMO |
$81.86
|
| Rate for Payer: Cigna of CA PPO |
$81.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.40
|
| Rate for Payer: Dignity Health Media |
$99.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.78
|
| Rate for Payer: Galaxy Health WC |
$99.40
|
| Rate for Payer: Global Benefits Group Commercial |
$70.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$87.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.07
|
| Rate for Payer: Multiplan Commercial |
$93.55
|
| Rate for Payer: Networks By Design Commercial |
$76.01
|
| Rate for Payer: Prime Health Services Commercial |
$99.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$70.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.47
|
| Rate for Payer: United Healthcare All Other HMO |
$58.47
|
| Rate for Payer: United Healthcare HMO Rider |
$58.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.40
|
| Rate for Payer: Vantage Medical Group Senior |
$99.40
|
|
|
TUCATINIB 50 MG TABLET [227736]
|
Facility
IP
|
$116.94
|
|
|
Service Code
|
NDC 51144-001-60
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Blue Shield of California Commercial |
$83.26
|
| Rate for Payer: Blue Shield of California EPN |
$59.87
|
| Rate for Payer: Cash Price |
$52.62
|
| Rate for Payer: Cigna of CA HMO |
$81.86
|
| Rate for Payer: Cigna of CA PPO |
$81.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.78
|
| Rate for Payer: Galaxy Health WC |
$99.40
|
| Rate for Payer: Global Benefits Group Commercial |
$70.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.07
|
| Rate for Payer: Multiplan Commercial |
$93.55
|
| Rate for Payer: Networks By Design Commercial |
$76.01
|
| Rate for Payer: Prime Health Services Commercial |
$99.40
|
|
|
Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch
|
Facility
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 69610
|
| Min. Negotiated Rate |
$270.92 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| Rate for Payer: IEHP Medi-Cal |
$3,086.81
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,086.81
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])
|
Facility
OP
|
$13,086.00
|
|
|
Service Code
|
CPT 69633
|
| Min. Negotiated Rate |
$311.24 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,999.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,999.72
|
| Rate for Payer: IEHP Medi-Cal |
$11,853.38
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,853.38
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction
|
Facility
OP
|
$13,086.00
|
|
|
Service Code
|
CPT 69631
|
| Min. Negotiated Rate |
$311.24 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,999.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,999.72
|
| Rate for Payer: IEHP Medi-Cal |
$11,853.38
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,853.38
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Tympanostomy (requiring insertion of ventilating tube), general anesthesia
|
Facility
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 69436
|
| Min. Negotiated Rate |
$229.20 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| Rate for Payer: IEHP Medi-Cal |
$3,086.81
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,086.81
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML INTRAMUSCULAR SYRINGE [14678]
|
Facility
IP
|
$293.26
|
|
|
Service Code
|
CPT 90691
|
| Hospital Charge Code |
NDG14678
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.38 |
| Max. Negotiated Rate |
$249.27 |
| Rate for Payer: Blue Shield of California Commercial |
$208.80
|
| Rate for Payer: Blue Shield of California EPN |
$150.15
|
| Rate for Payer: Cash Price |
$131.97
|
| Rate for Payer: Cigna of CA HMO |
$205.28
|
| Rate for Payer: Cigna of CA PPO |
$205.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$117.30
|
| Rate for Payer: Galaxy Health WC |
$249.27
|
| Rate for Payer: Global Benefits Group Commercial |
$175.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$195.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.38
|
| Rate for Payer: Multiplan Commercial |
$234.61
|
| Rate for Payer: Networks By Design Commercial |
$146.63
|
| Rate for Payer: Prime Health Services Commercial |
$249.27
|
|
|
TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML INTRAMUSCULAR SYRINGE [14678]
|
Facility
OP
|
$293.26
|
|
|
Service Code
|
CPT 90691
|
| Hospital Charge Code |
NDG14678
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.38 |
| Max. Negotiated Rate |
$864.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$864.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$249.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$161.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$161.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.29
|
| Rate for Payer: BCBS Transplant Transplant |
$175.96
|
| Rate for Payer: Blue Shield of California Commercial |
$216.13
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$131.97
|
| Rate for Payer: Cash Price |
$131.97
|
| Rate for Payer: Cigna of CA HMO |
$205.28
|
| Rate for Payer: Cigna of CA PPO |
$205.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.27
|
| Rate for Payer: Dignity Health Media |
$249.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$117.30
|
| Rate for Payer: Galaxy Health WC |
$249.27
|
| Rate for Payer: Global Benefits Group Commercial |
$175.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$219.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$195.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.38
|
| Rate for Payer: Multiplan Commercial |
$234.61
|
| Rate for Payer: Networks By Design Commercial |
$146.63
|
| Rate for Payer: Prime Health Services Commercial |
$249.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.63
|
| Rate for Payer: United Healthcare All Other HMO |
$146.63
|
| Rate for Payer: United Healthcare HMO Rider |
$146.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.27
|
| Rate for Payer: Vantage Medical Group Senior |
$249.27
|
|
|
Unlisted laparoscopy procedure, abdomen, peritoneum and omentum
|
Facility
OP
|
$11,823.10
|
|
|
Service Code
|
CPT 49329
|
| Min. Negotiated Rate |
$3,429.00 |
| Max. Negotiated Rate |
$11,823.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,823.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,823.10
|
| Rate for Payer: IEHP Medi-Cal |
$11,678.92
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,678.92
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
Unlisted laparoscopy procedure, oviduct, ovary
|
Facility
OP
|
$11,823.10
|
|
|
Service Code
|
CPT 58679
|
| Min. Negotiated Rate |
$7,209.21 |
| Max. Negotiated Rate |
$11,823.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,823.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,823.10
|
| Rate for Payer: IEHP Medi-Cal |
$11,678.92
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,678.92
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
Unlisted laparoscopy procedure, spleen
|
Facility
OP
|
$11,823.10
|
|
|
Service Code
|
CPT 38129
|
| Min. Negotiated Rate |
$7,209.21 |
| Max. Negotiated Rate |
$11,823.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,823.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,823.10
|
| Rate for Payer: IEHP Medi-Cal |
$11,678.92
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,678.92
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
Unlisted procedure, dentoalveolar structures
|
Facility
OP
|
$5,938.00
|
|
|
Service Code
|
CPT 41899
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: IEHP Medi-Cal |
$494.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$494.41
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
Unlisted procedure, humerus or elbow
|
Facility
OP
|
$3,429.00
|
|
|
Service Code
|
CPT 24999
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$477.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$477.32
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
Unlisted procedure, larynx
|
Facility
OP
|
$3,429.00
|
|
|
Service Code
|
CPT 31599
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: IEHP Medi-Cal |
$494.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$494.41
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
Unlisted procedure, palate, uvula
|
Facility
OP
|
$500.51
|
|
|
Service Code
|
CPT 42299
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$500.51 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: IEHP Medi-Cal |
$494.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$494.41
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
Unlisted procedure, pharynx, adenoids, or tonsils
|
Facility
OP
|
$3,429.00
|
|
|
Service Code
|
CPT 42999
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: IEHP Medi-Cal |
$494.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$494.41
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
Unlisted procedure, salivary glands or ducts
|
Facility
OP
|
$3,429.00
|
|
|
Service Code
|
CPT 42699
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: IEHP Medi-Cal |
$494.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$494.41
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
Unlisted procedure, stomach
|
Facility
OP
|
$3,429.00
|
|
|
Service Code
|
CPT 43999
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: IEHP Medi-Cal |
$1,834.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
Unlisted pulmonary service or procedure
|
Facility
OP
|
$320.08
|
|
|
Service Code
|
CPT 94799
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$320.08 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: IEHP Medi-Cal |
$316.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$316.18
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
UREA 10 % LOTION [19779]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 5898060880
|
| Hospital Charge Code |
NDG19779A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
|
|
UREA 10 % LOTION [19779]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 5898060880
|
| Hospital Charge Code |
NDG19779A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
