|
KIT FOR PREP TC-99M-MERTIATIDE (BETIATIDE) 1 MG INTRAVENOUS SOLUTION [225273]
|
Facility
|
IP
|
$498.77
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$423.95 |
| Rate for Payer: Adventist Health Commercial |
$99.75
|
| Rate for Payer: Blue Shield of California Commercial |
$383.55
|
| Rate for Payer: Blue Shield of California Commercial |
$252.88
|
| Rate for Payer: Cash Price |
$224.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.51
|
| Rate for Payer: EPIC Health Plan Senior |
$199.51
|
| Rate for Payer: Galaxy Health WC |
$423.95
|
| Rate for Payer: Global Benefits Group Commercial |
$299.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$399.02
|
| Rate for Payer: Networks By Design Commercial |
$324.20
|
| Rate for Payer: Prime Health Services Commercial |
$423.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.19
|
| Rate for Payer: United Healthcare All Other HMO |
$182.20
|
| Rate for Payer: United Healthcare HMO Rider |
$178.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.35
|
|
|
KIT FOR TC 99M-LABELED RED BLOOD CELLS INTRAVENOUS SOLUTION [225270]
|
Facility
|
OP
|
$181.13
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$36.23 |
| Max. Negotiated Rate |
$269.68 |
| Rate for Payer: Adventist Health Commercial |
$36.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$269.68
|
| Rate for Payer: Blue Shield of California Commercial |
$76.26
|
| Rate for Payer: Blue Shield of California Commercial |
$115.56
|
| Rate for Payer: Cash Price |
$81.51
|
| Rate for Payer: Cash Price |
$81.51
|
| Rate for Payer: Cigna of CA HMO |
$115.92
|
| Rate for Payer: Cigna of CA PPO |
$134.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.45
|
| Rate for Payer: EPIC Health Plan Senior |
$72.45
|
| Rate for Payer: Galaxy Health WC |
$153.96
|
| Rate for Payer: Global Benefits Group Commercial |
$108.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.79
|
| Rate for Payer: Multiplan Commercial |
$144.90
|
| Rate for Payer: Networks By Design Commercial |
$117.73
|
| Rate for Payer: Prime Health Services Commercial |
$153.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.98
|
| Rate for Payer: United Healthcare All Other HMO |
$66.17
|
| Rate for Payer: United Healthcare HMO Rider |
$64.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.96
|
| Rate for Payer: Vantage Medical Group Senior |
$153.96
|
|
|
KIT FOR TC 99M-LABELED RED BLOOD CELLS INTRAVENOUS SOLUTION [225270]
|
Facility
|
IP
|
$181.13
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$36.23 |
| Max. Negotiated Rate |
$153.96 |
| Rate for Payer: Adventist Health Commercial |
$36.23
|
| Rate for Payer: Blue Shield of California Commercial |
$91.83
|
| Rate for Payer: Blue Shield of California Commercial |
$139.29
|
| Rate for Payer: Cash Price |
$81.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.45
|
| Rate for Payer: EPIC Health Plan Senior |
$72.45
|
| Rate for Payer: Galaxy Health WC |
$153.96
|
| Rate for Payer: Global Benefits Group Commercial |
$108.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.47
|
| Rate for Payer: Multiplan Commercial |
$144.90
|
| Rate for Payer: Networks By Design Commercial |
$117.73
|
| Rate for Payer: Prime Health Services Commercial |
$153.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.98
|
| Rate for Payer: United Healthcare All Other HMO |
$66.17
|
| Rate for Payer: United Healthcare HMO Rider |
$64.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.32
|
|
|
KIT FOR THE PREPARATION OF GA-68-DOTATATE 40 MCG INTRAVENOUS SOLN [215477]
|
Facility
|
IP
|
$3,931.20
|
|
|
Service Code
|
HCPCS A9587
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$786.24 |
| Max. Negotiated Rate |
$3,341.52 |
| Rate for Payer: Adventist Health Commercial |
$786.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,993.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,023.09
|
| Rate for Payer: Cash Price |
$1,769.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,751.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,572.48
|
| Rate for Payer: Galaxy Health WC |
$3,341.52
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,496.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,319.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.49
|
| Rate for Payer: Multiplan Commercial |
$3,144.96
|
| Rate for Payer: Networks By Design Commercial |
$2,555.28
|
| Rate for Payer: Prime Health Services Commercial |
$3,341.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,475.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,436.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,405.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,287.47
|
|
|
KIT FOR THE PREPARATION OF GA-68-DOTATATE 40 MCG INTRAVENOUS SOLN [215477]
|
Facility
|
OP
|
$3,931.20
|
|
|
Service Code
|
HCPCS A9587
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$3,341.52 |
| Rate for Payer: Adventist Health Commercial |
$786.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,655.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2,508.11
|
| Rate for Payer: Cash Price |
$1,769.04
|
| Rate for Payer: Cash Price |
$1,769.04
|
| Rate for Payer: Cigna of CA HMO |
$2,515.97
|
| Rate for Payer: Cigna of CA PPO |
$2,909.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,751.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.89
|
| Rate for Payer: EPIC Health Plan Senior |
$54.59
|
| Rate for Payer: Galaxy Health WC |
$3,341.52
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,496.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.50
|
| Rate for Payer: Multiplan Commercial |
$3,144.96
|
| Rate for Payer: Networks By Design Commercial |
$2,555.28
|
| Rate for Payer: Prime Health Services Commercial |
$3,341.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,358.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,475.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,436.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,405.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,287.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.59
|
| Rate for Payer: Vantage Medical Group Senior |
$54.59
|
|
|
KIT FOR THE PREPARATION OF TC-99M-MEBROFENIN 45 MG IV SOLUTION [121131]
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$69.21
|
| Rate for Payer: Blue Shield of California Commercial |
$45.63
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
|
|
KIT FOR THE PREPARATION OF TC-99M-MEBROFENIN 45 MG IV SOLUTION [121131]
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$140.85 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.85
|
| Rate for Payer: Blue Shield of California Commercial |
$57.42
|
| Rate for Payer: Blue Shield of California Commercial |
$37.89
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
KIT FOR THE PREPARATION OF TC-99M-TETROFOSMIN 0.23 MG IV SOLUTION [98467]
|
Facility
|
OP
|
$127.60
|
|
|
Service Code
|
HCPCS A9502
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$268.26 |
| Rate for Payer: Adventist Health Commercial |
$25.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.26
|
| Rate for Payer: Blue Shield of California Commercial |
$81.41
|
| Rate for Payer: Blue Shield of California Commercial |
$53.72
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cigna of CA HMO |
$81.66
|
| Rate for Payer: Cigna of CA PPO |
$94.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.04
|
| Rate for Payer: EPIC Health Plan Senior |
$51.04
|
| Rate for Payer: Galaxy Health WC |
$108.46
|
| Rate for Payer: Global Benefits Group Commercial |
$76.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.32
|
| Rate for Payer: Multiplan Commercial |
$102.08
|
| Rate for Payer: Networks By Design Commercial |
$82.94
|
| Rate for Payer: Prime Health Services Commercial |
$108.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.89
|
| Rate for Payer: United Healthcare All Other HMO |
$46.61
|
| Rate for Payer: United Healthcare HMO Rider |
$45.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.46
|
| Rate for Payer: Vantage Medical Group Senior |
$108.46
|
|
|
KIT FOR THE PREPARATION OF TC-99M-TETROFOSMIN 0.23 MG IV SOLUTION [98467]
|
Facility
|
IP
|
$127.60
|
|
|
Service Code
|
HCPCS A9502
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$108.46 |
| Rate for Payer: Adventist Health Commercial |
$25.52
|
| Rate for Payer: Blue Shield of California Commercial |
$98.12
|
| Rate for Payer: Blue Shield of California Commercial |
$64.69
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.04
|
| Rate for Payer: EPIC Health Plan Senior |
$51.04
|
| Rate for Payer: Galaxy Health WC |
$108.46
|
| Rate for Payer: Global Benefits Group Commercial |
$76.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$102.08
|
| Rate for Payer: Networks By Design Commercial |
$82.94
|
| Rate for Payer: Prime Health Services Commercial |
$108.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.89
|
| Rate for Payer: United Healthcare All Other HMO |
$46.61
|
| Rate for Payer: United Healthcare HMO Rider |
$45.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.79
|
|
|
KIT FOR THE PREP OF TC-99M-TILMANOCEPT 250 MCG SOLUTION FOR INJECTION [223025]
|
Facility
|
OP
|
$755.82
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$151.16 |
| Max. Negotiated Rate |
$642.45 |
| Rate for Payer: Adventist Health Commercial |
$151.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$642.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$415.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$566.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.46
|
| Rate for Payer: Blue Shield of California Commercial |
$318.20
|
| Rate for Payer: Blue Shield of California Commercial |
$482.21
|
| Rate for Payer: Cash Price |
$340.12
|
| Rate for Payer: Cash Price |
$340.12
|
| Rate for Payer: Cigna of CA HMO |
$483.72
|
| Rate for Payer: Cigna of CA PPO |
$559.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$642.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$642.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$642.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.33
|
| Rate for Payer: EPIC Health Plan Senior |
$302.33
|
| Rate for Payer: Galaxy Health WC |
$642.45
|
| Rate for Payer: Global Benefits Group Commercial |
$453.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$479.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$445.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$529.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.07
|
| Rate for Payer: Multiplan Commercial |
$604.66
|
| Rate for Payer: Networks By Design Commercial |
$491.28
|
| Rate for Payer: Prime Health Services Commercial |
$642.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.66
|
| Rate for Payer: United Healthcare All Other HMO |
$276.10
|
| Rate for Payer: United Healthcare HMO Rider |
$270.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$642.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$642.45
|
| Rate for Payer: Vantage Medical Group Senior |
$642.45
|
|
|
KIT FOR THE PREP OF TC-99M-TILMANOCEPT 250 MCG SOLUTION FOR INJECTION [223025]
|
Facility
|
IP
|
$755.82
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$151.16 |
| Max. Negotiated Rate |
$642.45 |
| Rate for Payer: Adventist Health Commercial |
$151.16
|
| Rate for Payer: Blue Shield of California Commercial |
$383.20
|
| Rate for Payer: Blue Shield of California Commercial |
$581.23
|
| Rate for Payer: Cash Price |
$340.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.33
|
| Rate for Payer: EPIC Health Plan Senior |
$302.33
|
| Rate for Payer: Galaxy Health WC |
$642.45
|
| Rate for Payer: Global Benefits Group Commercial |
$453.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$479.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$445.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.40
|
| Rate for Payer: Multiplan Commercial |
$604.66
|
| Rate for Payer: Networks By Design Commercial |
$491.28
|
| Rate for Payer: Prime Health Services Commercial |
$642.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.66
|
| Rate for Payer: United Healthcare All Other HMO |
$276.10
|
| Rate for Payer: United Healthcare HMO Rider |
$270.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.53
|
|
|
KIT OSTOMY SENSURA FLEX
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
|
|
KIT OSTOMY SENSURA FLEX
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$14.04 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.52
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$8.50
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.29
|
| Rate for Payer: Vantage Medical Group Senior |
$11.29
|
|
|
KIT PREPARATION OF TC 99M-SESTAMIBI COMBO NO.1 IV SOLUTION [121547]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$27.68
|
| Rate for Payer: Blue Shield of California Commercial |
$18.25
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
|
|
KIT PREPARATION OF TC 99M-SESTAMIBI COMBO NO.1 IV SOLUTION [121547]
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$272.73 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.73
|
| Rate for Payer: Blue Shield of California Commercial |
$22.97
|
| Rate for Payer: Blue Shield of California Commercial |
$15.16
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$163.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
KIT PREPARATION OF TC-99M-SODIUM PYROPHOSPHATE 12 MG IV SOLUTION [121139]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS A9538
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$46.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.42
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
|
|
KIT PREPARATION OF TC-99M-SODIUM PYROPHOSPHATE 12 MG IV SOLUTION [121139]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS A9538
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$121.69 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.43
|
| Rate for Payer: Blue Shield of California Commercial |
$38.28
|
| Rate for Payer: Blue Shield of California Commercial |
$25.26
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$54,665.93
|
|
|
Service Code
|
APR-DRG 3133
|
| Min. Negotiated Rate |
$43,660.81 |
| Max. Negotiated Rate |
$54,665.93 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43,660.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54,665.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,911.62
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$108,846.82
|
|
|
Service Code
|
APR-DRG 3134
|
| Min. Negotiated Rate |
$86,934.24 |
| Max. Negotiated Rate |
$108,846.82 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86,934.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108,846.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$97,389.26
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$38,867.62
|
|
|
Service Code
|
APR-DRG 3132
|
| Min. Negotiated Rate |
$31,042.95 |
| Max. Negotiated Rate |
$38,867.62 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31,042.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38,867.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,776.29
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$29,209.17
|
|
|
Service Code
|
APR-DRG 3131
|
| Min. Negotiated Rate |
$23,328.91 |
| Max. Negotiated Rate |
$29,209.17 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,328.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,209.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,134.53
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC
|
Facility
|
IP
|
$110,638.44
|
|
|
Service Code
|
MSDRG 488
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$110,638.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,189.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$110,638.44
|
| Rate for Payer: EPIC Health Plan Senior |
$73,758.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67,053.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93,875.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89,851.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$99,067.04
|
|
|
Service Code
|
MSDRG 489
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$99,067.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,856.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$99,067.04
|
| Rate for Payer: EPIC Health Plan Senior |
$66,044.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,040.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,056.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80,454.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC
|
Facility
|
IP
|
$116,355.84
|
|
|
Service Code
|
MSDRG 486
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$116,355.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63,393.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$116,355.84
|
| Rate for Payer: EPIC Health Plan Senior |
$77,570.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70,518.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$98,726.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94,495.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC
|
Facility
|
IP
|
$136,513.95
|
|
|
Service Code
|
MSDRG 485
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$136,513.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97,832.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$136,513.95
|
| Rate for Payer: EPIC Health Plan Senior |
$91,009.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$82,735.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115,830.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110,865.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
