|
TENDONITIS, MYOSITIS AND BURSITIS WITH MCC
|
Facility
|
IP
|
$105,634.42
|
|
|
Service Code
|
MSDRG 557
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$105,634.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,076.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$105,634.42
|
| Rate for Payer: EPIC Health Plan Senior |
$70,422.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64,020.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89,629.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85,787.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC
|
Facility
|
IP
|
$95,099.30
|
|
|
Service Code
|
MSDRG 558
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$95,099.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,078.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$95,099.30
|
| Rate for Payer: EPIC Health Plan Senior |
$63,399.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,635.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80,690.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77,232.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$90,186.37
|
|
|
Service Code
|
APR-DRG 3174
|
| Min. Negotiated Rate |
$72,030.43 |
| Max. Negotiated Rate |
$90,186.37 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72,030.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90,186.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80,693.07
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$40,852.60
|
|
|
Service Code
|
APR-DRG 3173
|
| Min. Negotiated Rate |
$32,628.33 |
| Max. Negotiated Rate |
$40,852.60 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32,628.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,852.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,552.33
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$27,882.23
|
|
|
Service Code
|
APR-DRG 3172
|
| Min. Negotiated Rate |
$22,269.10 |
| Max. Negotiated Rate |
$27,882.23 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,269.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,882.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,947.26
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$21,388.89
|
|
|
Service Code
|
APR-DRG 3171
|
| Min. Negotiated Rate |
$17,082.97 |
| Max. Negotiated Rate |
$21,388.89 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,082.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,388.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,137.43
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$70.68 |
| 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 |
$6,716.00
|
| 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 |
$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 |
$70.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.93
|
| 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
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]
|
Facility
|
OP
|
$10,255.42
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$8,717.11 |
| Rate for Payer: Adventist Health Commercial |
$2,051.08
|
| Rate for Payer: Adventist Health Commercial |
$1,991.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,021.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,021.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.00
|
| Rate for Payer: Blue Shield of California Commercial |
$187.86
|
| Rate for Payer: Blue Shield of California Commercial |
$187.86
|
| Rate for Payer: Cash Price |
$4,614.94
|
| Rate for Payer: Cash Price |
$4,614.94
|
| Rate for Payer: Cash Price |
$4,480.52
|
| Rate for Payer: Cash Price |
$4,480.52
|
| Rate for Payer: Cigna of CA HMO |
$6,969.70
|
| Rate for Payer: Cigna of CA HMO |
$7,178.79
|
| Rate for Payer: Cigna of CA PPO |
$6,969.70
|
| Rate for Payer: Cigna of CA PPO |
$7,178.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,178.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,969.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.74
|
| Rate for Payer: EPIC Health Plan Senior |
$239.16
|
| Rate for Payer: EPIC Health Plan Senior |
$239.16
|
| Rate for Payer: Galaxy Health WC |
$8,717.11
|
| Rate for Payer: Galaxy Health WC |
$8,463.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,153.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,974.03
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$356.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$356.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,322.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,512.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,722.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,614.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$304.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$304.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,461.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.34
|
| Rate for Payer: Multiplan Commercial |
$8,204.34
|
| Rate for Payer: Multiplan Commercial |
$7,965.37
|
| Rate for Payer: Networks By Design Commercial |
$4,978.35
|
| Rate for Payer: Networks By Design Commercial |
$5,127.71
|
| Rate for Payer: Prime Health Services Commercial |
$8,717.11
|
| Rate for Payer: Prime Health Services Commercial |
$8,463.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,974.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,153.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,153.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,974.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,736.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,848.86
|
| Rate for Payer: United Healthcare All Other HMO |
$3,746.30
|
| Rate for Payer: United Healthcare All Other HMO |
$3,637.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3,665.29
|
| Rate for Payer: United Healthcare HMO Rider |
$3,558.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,260.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,358.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Vantage Medical Group Senior |
$239.16
|
| Rate for Payer: Vantage Medical Group Senior |
$239.16
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]
|
Facility
|
IP
|
$9,956.71
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,991.34 |
| Max. Negotiated Rate |
$8,463.20 |
| Rate for Payer: Adventist Health Commercial |
$1,991.34
|
| Rate for Payer: Adventist Health Commercial |
$2,051.08
|
| Rate for Payer: Blue Shield of California Commercial |
$7,886.42
|
| Rate for Payer: Blue Shield of California Commercial |
$5,048.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7,656.71
|
| Rate for Payer: Blue Shield of California Commercial |
$5,199.50
|
| Rate for Payer: Cash Price |
$4,614.94
|
| Rate for Payer: Cash Price |
$4,480.52
|
| Rate for Payer: Cigna of CA HMO |
$6,969.70
|
| Rate for Payer: Cigna of CA HMO |
$7,178.79
|
| Rate for Payer: Cigna of CA PPO |
$7,178.79
|
| Rate for Payer: Cigna of CA PPO |
$6,969.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,178.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,969.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,102.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,982.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4,102.17
|
| Rate for Payer: EPIC Health Plan Senior |
$3,982.68
|
| Rate for Payer: Galaxy Health WC |
$8,717.11
|
| Rate for Payer: Galaxy Health WC |
$8,463.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,974.03
|
| Rate for Payer: Global Benefits Group Commercial |
$6,153.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,512.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,322.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,050.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,874.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,461.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.61
|
| Rate for Payer: Multiplan Commercial |
$8,204.34
|
| Rate for Payer: Multiplan Commercial |
$7,965.37
|
| Rate for Payer: Networks By Design Commercial |
$4,978.35
|
| Rate for Payer: Networks By Design Commercial |
$5,127.71
|
| Rate for Payer: Prime Health Services Commercial |
$8,463.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,717.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,848.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,736.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3,637.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3,746.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,665.29
|
| Rate for Payer: United Healthcare HMO Rider |
$3,558.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,358.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,260.82
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
|
IP
|
$64.67
|
|
|
Service Code
|
NDC 6195823011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$54.97 |
| Rate for Payer: Adventist Health Commercial |
$12.93
|
| Rate for Payer: Blue Shield of California Commercial |
$32.79
|
| Rate for Payer: Blue Shield of California Commercial |
$49.73
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna of CA HMO |
$45.27
|
| Rate for Payer: Cigna of CA PPO |
$45.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.87
|
| Rate for Payer: EPIC Health Plan Senior |
$25.87
|
| Rate for Payer: Galaxy Health WC |
$54.97
|
| Rate for Payer: Global Benefits Group Commercial |
$38.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.52
|
| Rate for Payer: Multiplan Commercial |
$51.74
|
| Rate for Payer: Networks By Design Commercial |
$42.04
|
| Rate for Payer: Prime Health Services Commercial |
$54.97
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
|
OP
|
$64.67
|
|
|
Service Code
|
NDC 6195823011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$54.97 |
| Rate for Payer: Adventist Health Commercial |
$12.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.50
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna of CA HMO |
$45.27
|
| Rate for Payer: Cigna of CA PPO |
$45.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.87
|
| Rate for Payer: EPIC Health Plan Senior |
$25.87
|
| Rate for Payer: Galaxy Health WC |
$54.97
|
| Rate for Payer: Global Benefits Group Commercial |
$38.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.27
|
| Rate for Payer: Multiplan Commercial |
$51.74
|
| Rate for Payer: Networks By Design Commercial |
$42.04
|
| Rate for Payer: Prime Health Services Commercial |
$54.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.34
|
| Rate for Payer: United Healthcare All Other HMO |
$32.34
|
| Rate for Payer: United Healthcare HMO Rider |
$32.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Vantage Medical Group Senior |
$54.97
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
OP
|
$1.15
|
|
|
Service Code
|
NDC 6909753302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Vantage Medical Group Senior |
$0.98
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 5026875811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.81
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Senior |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Networks By Design Commercial |
$1.83
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.41
|
| Rate for Payer: United Healthcare HMO Rider |
$1.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2.40
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 5026875811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Senior |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Networks By Design Commercial |
$1.83
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 5026875812
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Senior |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Networks By Design Commercial |
$1.83
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
IP
|
$1.15
|
|
|
Service Code
|
NDC 6909753302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 5026875812
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.81
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Senior |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Networks By Design Commercial |
$1.83
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.41
|
| Rate for Payer: United Healthcare HMO Rider |
$1.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2.40
|
|
|
TENOTOMY, ADDUCTOR OF HIP, PERCUTANEOUS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 27000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$358.39 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| 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 |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| 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 |
$358.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$405.33
|
| 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 |
$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 |
$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
|
|
|
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 27606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$366.53 |
| 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 |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$366.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$414.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); LOCAL ANESTHESIA
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 27605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$296.47 |
| 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 |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 |
$296.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$335.29
|
| 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 |
$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 |
$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
|
|
|
TENOTOMY, PERCUTANEOUS, ADDUCTOR OR HAMSTRING; SINGLE TENDON (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 27306
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$330.24 |
| 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 |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$330.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$373.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
TENOTOMY, PERCUTANEOUS, TOE; MULTIPLE TENDONS
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 28011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$324.61 |
| 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 |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| 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 |
$324.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.12
|
| 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 |
$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 |
$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
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION [226977]
|
Facility
|
IP
|
$23,342.20
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,668.44 |
| Max. Negotiated Rate |
$19,840.87 |
| Rate for Payer: Adventist Health Commercial |
$4,668.44
|
| Rate for Payer: Blue Shield of California Commercial |
$11,834.50
|
| Rate for Payer: Blue Shield of California Commercial |
$17,950.15
|
| Rate for Payer: Cash Price |
$10,503.99
|
| Rate for Payer: Cigna of CA HMO |
$16,339.54
|
| Rate for Payer: Cigna of CA PPO |
$16,339.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,339.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,336.88
|
| Rate for Payer: EPIC Health Plan Senior |
$9,336.88
|
| Rate for Payer: Galaxy Health WC |
$19,840.87
|
| Rate for Payer: Global Benefits Group Commercial |
$14,005.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,822.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,771.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,602.13
|
| Rate for Payer: Multiplan Commercial |
$18,673.76
|
| Rate for Payer: Networks By Design Commercial |
$11,671.10
|
| Rate for Payer: Prime Health Services Commercial |
$19,840.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,760.33
|
| Rate for Payer: United Healthcare All Other HMO |
$8,526.91
|
| Rate for Payer: United Healthcare HMO Rider |
$8,342.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,644.57
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION [226977]
|
Facility
|
OP
|
$23,342.20
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$379.90 |
| Max. Negotiated Rate |
$19,840.87 |
| Rate for Payer: Adventist Health Commercial |
$4,668.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,217.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$474.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$417.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$761.34
|
| Rate for Payer: Blue Shield of California Commercial |
$408.42
|
| Rate for Payer: Cash Price |
$10,503.99
|
| Rate for Payer: Cash Price |
$10,503.99
|
| Rate for Payer: Cigna of CA HMO |
$16,339.54
|
| Rate for Payer: Cigna of CA PPO |
$16,339.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$474.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$417.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,339.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.84
|
| Rate for Payer: EPIC Health Plan Senior |
$417.89
|
| Rate for Payer: Galaxy Health WC |
$19,840.87
|
| Rate for Payer: Global Benefits Group Commercial |
$14,005.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$623.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$379.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,822.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$701.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$531.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,602.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$509.07
|
| Rate for Payer: Multiplan Commercial |
$18,673.76
|
| Rate for Payer: Networks By Design Commercial |
$11,671.10
|
| Rate for Payer: Prime Health Services Commercial |
$19,840.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,005.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,005.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,760.33
|
| Rate for Payer: United Healthcare All Other HMO |
$8,526.91
|
| Rate for Payer: United Healthcare HMO Rider |
$8,342.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,644.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$474.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.89
|
| Rate for Payer: Vantage Medical Group Senior |
$417.89
|
|
|
TERAZOSIN 1 MG CAPSULE [14550]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 5974638306
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
