|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
OP
|
$113.81
|
|
|
Service Code
|
NDC 7297412001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$96.74 |
| Rate for Payer: Adventist Health Commercial |
$22.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.03
|
| Rate for Payer: Cash Price |
$51.21
|
| Rate for Payer: Cigna of CA HMO |
$79.67
|
| Rate for Payer: Cigna of CA PPO |
$79.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.52
|
| Rate for Payer: EPIC Health Plan Senior |
$45.52
|
| Rate for Payer: Galaxy Health WC |
$96.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.67
|
| Rate for Payer: Multiplan Commercial |
$91.05
|
| Rate for Payer: Networks By Design Commercial |
$73.98
|
| Rate for Payer: Prime Health Services Commercial |
$96.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.91
|
| Rate for Payer: United Healthcare All Other HMO |
$56.91
|
| Rate for Payer: United Healthcare HMO Rider |
$56.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.74
|
| Rate for Payer: Vantage Medical Group Senior |
$96.74
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
IP
|
$113.81
|
|
|
Service Code
|
NDC 7297412001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$96.74 |
| Rate for Payer: Adventist Health Commercial |
$22.76
|
| Rate for Payer: Blue Shield of California Commercial |
$57.70
|
| Rate for Payer: Blue Shield of California Commercial |
$87.52
|
| Rate for Payer: Cash Price |
$51.21
|
| Rate for Payer: Cigna of CA HMO |
$79.67
|
| Rate for Payer: Cigna of CA PPO |
$79.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.52
|
| Rate for Payer: EPIC Health Plan Senior |
$45.52
|
| Rate for Payer: Galaxy Health WC |
$96.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.31
|
| Rate for Payer: Multiplan Commercial |
$91.05
|
| Rate for Payer: Networks By Design Commercial |
$73.98
|
| Rate for Payer: Prime Health Services Commercial |
$96.74
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]
|
Facility
|
IP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.07 |
| Max. Negotiated Rate |
$722.81 |
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Blue Shield of California Commercial |
$431.13
|
| Rate for Payer: Blue Shield of California Commercial |
$653.93
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cigna of CA HMO |
$595.25
|
| Rate for Payer: Cigna of CA PPO |
$595.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.14
|
| Rate for Payer: EPIC Health Plan Senior |
$340.14
|
| Rate for Payer: Galaxy Health WC |
$722.81
|
| Rate for Payer: Global Benefits Group Commercial |
$510.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.09
|
| Rate for Payer: Multiplan Commercial |
$680.29
|
| Rate for Payer: Networks By Design Commercial |
$425.18
|
| Rate for Payer: Prime Health Services Commercial |
$722.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.14
|
| Rate for Payer: United Healthcare All Other HMO |
$310.64
|
| Rate for Payer: United Healthcare HMO Rider |
$303.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.49
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]
|
Facility
|
OP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$722.81 |
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7.19
|
| Rate for Payer: Cigna of CA HMO |
$595.25
|
| Rate for Payer: Cigna of CA PPO |
$595.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.39
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$722.81
|
| Rate for Payer: Global Benefits Group Commercial |
$510.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.06
|
| Rate for Payer: Multiplan Commercial |
$680.29
|
| Rate for Payer: Networks By Design Commercial |
$425.18
|
| Rate for Payer: Prime Health Services Commercial |
$722.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.14
|
| Rate for Payer: United Healthcare All Other HMO |
$310.64
|
| Rate for Payer: United Healthcare HMO Rider |
$303.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8.26
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
OP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$722.81 |
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7.19
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cigna of CA HMO |
$595.25
|
| Rate for Payer: Cigna of CA PPO |
$595.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.39
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$722.81
|
| Rate for Payer: Global Benefits Group Commercial |
$510.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.06
|
| Rate for Payer: Multiplan Commercial |
$680.29
|
| Rate for Payer: Networks By Design Commercial |
$425.18
|
| Rate for Payer: Prime Health Services Commercial |
$722.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.14
|
| Rate for Payer: United Healthcare All Other HMO |
$310.64
|
| Rate for Payer: United Healthcare HMO Rider |
$303.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8.26
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
IP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.07 |
| Max. Negotiated Rate |
$722.81 |
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Blue Shield of California Commercial |
$431.13
|
| Rate for Payer: Blue Shield of California Commercial |
$653.93
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cigna of CA HMO |
$595.25
|
| Rate for Payer: Cigna of CA PPO |
$595.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.14
|
| Rate for Payer: EPIC Health Plan Senior |
$340.14
|
| Rate for Payer: Galaxy Health WC |
$722.81
|
| Rate for Payer: Global Benefits Group Commercial |
$510.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.09
|
| Rate for Payer: Multiplan Commercial |
$680.29
|
| Rate for Payer: Networks By Design Commercial |
$425.18
|
| Rate for Payer: Prime Health Services Commercial |
$722.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.14
|
| Rate for Payer: United Healthcare All Other HMO |
$310.64
|
| Rate for Payer: United Healthcare HMO Rider |
$303.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.49
|
|
|
REMESTEMCEL-L-RKND 6.68 X 10EXP6 CELL/ML INTRAVENOUS SUSPENSION [245044]
|
Facility
|
OP
|
$232,800.00
|
|
|
Service Code
|
HCPCS J3402
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46,560.00 |
| Max. Negotiated Rate |
$336,038.60 |
| Rate for Payer: Adventist Health Commercial |
$46,560.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152,693.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305,489.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224,025.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$203,659.76
|
| Rate for Payer: Cash Price |
$104,760.00
|
| Rate for Payer: Cash Price |
$104,760.00
|
| Rate for Payer: Cigna of CA HMO |
$162,960.00
|
| Rate for Payer: Cigna of CA PPO |
$162,960.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305,489.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$224,025.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$203,659.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162,960.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336,038.60
|
| Rate for Payer: EPIC Health Plan Senior |
$224,025.74
|
| Rate for Payer: Galaxy Health WC |
$197,880.00
|
| Rate for Payer: Global Benefits Group Commercial |
$139,680.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334,002.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$203,659.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$203,659.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147,828.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127,723.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$285,123.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55,872.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$256,611.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$272,904.08
|
| Rate for Payer: Multiplan Commercial |
$186,240.00
|
| Rate for Payer: Networks By Design Commercial |
$116,400.00
|
| Rate for Payer: Prime Health Services Commercial |
$197,880.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139,680.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139,680.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$87,369.84
|
| Rate for Payer: United Healthcare All Other HMO |
$85,041.84
|
| Rate for Payer: United Healthcare HMO Rider |
$83,202.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76,242.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$203,659.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305,489.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224,025.74
|
| Rate for Payer: Vantage Medical Group Senior |
$203,659.76
|
|
|
REMESTEMCEL-L-RKND 6.68 X 10EXP6 CELL/ML INTRAVENOUS SUSPENSION [245044]
|
Facility
|
IP
|
$232,800.00
|
|
|
Service Code
|
HCPCS J3402
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46,560.00 |
| Max. Negotiated Rate |
$197,880.00 |
| Rate for Payer: Adventist Health Commercial |
$46,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$118,029.60
|
| Rate for Payer: Blue Shield of California Commercial |
$179,023.20
|
| Rate for Payer: Cash Price |
$104,760.00
|
| Rate for Payer: Cigna of CA HMO |
$162,960.00
|
| Rate for Payer: Cigna of CA PPO |
$162,960.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162,960.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$93,120.00
|
| Rate for Payer: Galaxy Health WC |
$197,880.00
|
| Rate for Payer: Global Benefits Group Commercial |
$139,680.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147,828.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137,352.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55,872.00
|
| Rate for Payer: Multiplan Commercial |
$186,240.00
|
| Rate for Payer: Networks By Design Commercial |
$116,400.00
|
| Rate for Payer: Prime Health Services Commercial |
$197,880.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$87,369.84
|
| Rate for Payer: United Healthcare All Other HMO |
$85,041.84
|
| Rate for Payer: United Healthcare HMO Rider |
$83,202.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76,242.00
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$87.97
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Blue Shield of California Commercial |
$62.16
|
| Rate for Payer: Blue Shield of California Commercial |
$44.60
|
| Rate for Payer: Blue Shield of California Commercial |
$67.65
|
| Rate for Payer: Blue Shield of California Commercial |
$40.98
|
| Rate for Payer: Cash Price |
$36.37
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cigna of CA HMO |
$61.58
|
| Rate for Payer: Cigna of CA HMO |
$56.58
|
| Rate for Payer: Cigna of CA PPO |
$56.58
|
| Rate for Payer: Cigna of CA PPO |
$61.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Senior |
$32.33
|
| Rate for Payer: EPIC Health Plan Senior |
$35.19
|
| Rate for Payer: Galaxy Health WC |
$68.71
|
| Rate for Payer: Galaxy Health WC |
$74.77
|
| Rate for Payer: Global Benefits Group Commercial |
$52.78
|
| Rate for Payer: Global Benefits Group Commercial |
$48.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.11
|
| Rate for Payer: Multiplan Commercial |
$64.66
|
| Rate for Payer: Multiplan Commercial |
$70.38
|
| Rate for Payer: Networks By Design Commercial |
$43.98
|
| Rate for Payer: Networks By Design Commercial |
$40.41
|
| Rate for Payer: Prime Health Services Commercial |
$74.77
|
| Rate for Payer: Prime Health Services Commercial |
$68.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.02
|
| Rate for Payer: United Healthcare All Other HMO |
$32.14
|
| Rate for Payer: United Healthcare All Other HMO |
$29.53
|
| Rate for Payer: United Healthcare HMO Rider |
$28.89
|
| Rate for Payer: United Healthcare HMO Rider |
$31.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.81
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$87.97
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.98
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cash Price |
$36.37
|
| Rate for Payer: Cigna of CA HMO |
$56.58
|
| Rate for Payer: Cigna of CA HMO |
$61.58
|
| Rate for Payer: Cigna of CA PPO |
$56.58
|
| Rate for Payer: Cigna of CA PPO |
$61.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.33
|
| Rate for Payer: EPIC Health Plan Senior |
$32.33
|
| Rate for Payer: EPIC Health Plan Senior |
$35.19
|
| Rate for Payer: Galaxy Health WC |
$74.77
|
| Rate for Payer: Galaxy Health WC |
$68.71
|
| Rate for Payer: Global Benefits Group Commercial |
$52.78
|
| Rate for Payer: Global Benefits Group Commercial |
$48.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.58
|
| Rate for Payer: Multiplan Commercial |
$64.66
|
| Rate for Payer: Multiplan Commercial |
$70.38
|
| Rate for Payer: Networks By Design Commercial |
$43.98
|
| Rate for Payer: Networks By Design Commercial |
$40.41
|
| Rate for Payer: Prime Health Services Commercial |
$74.77
|
| Rate for Payer: Prime Health Services Commercial |
$68.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.02
|
| Rate for Payer: United Healthcare All Other HMO |
$32.14
|
| Rate for Payer: United Healthcare All Other HMO |
$29.53
|
| Rate for Payer: United Healthcare HMO Rider |
$31.44
|
| Rate for Payer: United Healthcare HMO Rider |
$28.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.71
|
| Rate for Payer: Vantage Medical Group Senior |
$68.71
|
| Rate for Payer: Vantage Medical Group Senior |
$74.77
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$154.34
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$131.19 |
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.25
|
| Rate for Payer: Cash Price |
$72.75
|
| Rate for Payer: Cash Price |
$69.45
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA HMO |
$108.04
|
| Rate for Payer: Cigna of CA HMO |
$113.16
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$113.16
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$61.74
|
| Rate for Payer: EPIC Health Plan Senior |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.41
|
| Rate for Payer: Galaxy Health WC |
$131.19
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$92.60
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Global Benefits Group Commercial |
$97.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$123.47
|
| Rate for Payer: Multiplan Commercial |
$129.33
|
| Rate for Payer: Networks By Design Commercial |
$77.17
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$80.83
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Prime Health Services Commercial |
$137.41
|
| Rate for Payer: Prime Health Services Commercial |
$131.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$56.38
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare All Other HMO |
$59.05
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare HMO Rider |
$57.78
|
| Rate for Payer: United Healthcare HMO Rider |
$55.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.41
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$137.41
|
| Rate for Payer: Vantage Medical Group Senior |
$131.19
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Blue Shield of California Commercial |
$78.25
|
| Rate for Payer: Blue Shield of California Commercial |
$113.04
|
| Rate for Payer: Blue Shield of California Commercial |
$74.53
|
| Rate for Payer: Blue Shield of California Commercial |
$81.96
|
| Rate for Payer: Blue Shield of California Commercial |
$124.32
|
| Rate for Payer: Blue Shield of California Commercial |
$118.69
|
| Rate for Payer: Cash Price |
$72.75
|
| Rate for Payer: Cash Price |
$69.45
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$113.16
|
| Rate for Payer: Cigna of CA HMO |
$108.04
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$113.16
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$61.74
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.41
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Galaxy Health WC |
$131.19
|
| Rate for Payer: Global Benefits Group Commercial |
$92.60
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Global Benefits Group Commercial |
$97.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$123.47
|
| Rate for Payer: Multiplan Commercial |
$129.33
|
| Rate for Payer: Networks By Design Commercial |
$77.17
|
| Rate for Payer: Networks By Design Commercial |
$80.83
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Prime Health Services Commercial |
$131.19
|
| Rate for Payer: Prime Health Services Commercial |
$137.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.67
|
| Rate for Payer: United Healthcare All Other HMO |
$59.05
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare All Other HMO |
$56.38
|
| Rate for Payer: United Healthcare HMO Rider |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$57.78
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.55
|
|
|
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 69205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$135.11 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$51.29 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 11982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$188.88 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$213.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$804.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 20680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$255.19 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$255.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 20670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$194.53 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR; DUAL LEAD SYSTEM
|
Facility
|
OP
|
$50,447.00
|
|
|
Service Code
|
CPT 33228
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$486.61 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,787.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,443.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,934.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,787.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,443.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,180.97
|
| Rate for Payer: EPIC Health Plan Senior |
$14,787.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,046.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$486.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,443.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$550.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,820.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,938.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,013.63
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,443.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,787.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13,443.01
|
|
|
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 11200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 20694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$337.13 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$337.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,895.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
REMOVAL WITH REINSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 11983
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$304.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$804.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
RENAL DIALYSIS ACCESS DEVICE PROCEDURES
|
Facility
|
IP
|
$33,116.60
|
|
|
Service Code
|
APR-DRG 4442
|
| Min. Negotiated Rate |
$26,449.71 |
| Max. Negotiated Rate |
$33,116.60 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,449.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,116.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,630.64
|
|
|
RENAL DIALYSIS ACCESS DEVICE PROCEDURES
|
Facility
|
IP
|
$47,087.62
|
|
|
Service Code
|
APR-DRG 4443
|
| Min. Negotiated Rate |
$37,608.14 |
| Max. Negotiated Rate |
$47,087.62 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37,608.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47,087.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,131.03
|
|
|
RENAL DIALYSIS ACCESS DEVICE PROCEDURES
|
Facility
|
IP
|
$103,080.21
|
|
|
Service Code
|
APR-DRG 4444
|
| Min. Negotiated Rate |
$82,328.53 |
| Max. Negotiated Rate |
$103,080.21 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82,328.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103,080.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92,229.66
|
|
|
RENAL DIALYSIS ACCESS DEVICE PROCEDURES
|
Facility
|
IP
|
$23,082.93
|
|
|
Service Code
|
APR-DRG 4441
|
| Min. Negotiated Rate |
$18,435.97 |
| Max. Negotiated Rate |
$23,082.93 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18,435.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,082.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,653.15
|
|
