|
ADENOSINE 6 MG/2 ML VIAL - CODE [4080560]
|
Facility
IP
|
$1.44
|
|
|
Service Code
|
CPT J0153
|
| Hospital Charge Code |
1720684
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
ADENOSINE 6 MG/2 ML VIAL - CODE [4080560]
|
Facility
OP
|
$1.44
|
|
|
Service Code
|
CPT J0153
|
| Hospital Charge Code |
1720684
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.08
|
| Rate for Payer: IEHP medi-cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Riverside University Health MISP |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION [15330]
|
Facility
OP
|
$7.76
|
|
|
Service Code
|
CPT J0153
|
| Hospital Charge Code |
1720905
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| Rate for Payer: BCBS Transplant Transplant |
$2.74
|
| Rate for Payer: BCBS Transplant Transplant |
$3.07
|
| Rate for Payer: BCBS Transplant Transplant |
$3.43
|
| Rate for Payer: BCBS Transplant Transplant |
$4.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.66
|
| Rate for Payer: Central Health Plan Commercial |
$4.09
|
| Rate for Payer: Cigna of CA HMO |
$5.43
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$4.00
|
| Rate for Payer: Cigna of CA PPO |
$5.43
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$4.00
|
| Rate for Payer: Cigna of CA PPO |
$3.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$6.60
|
| Rate for Payer: Galaxy Health WC |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$3.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.74
|
| Rate for Payer: Global Benefits Group Commercial |
$4.66
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.43
|
| Rate for Payer: IEHP medi-cal |
$0.42
|
| Rate for Payer: IEHP medi-cal |
$0.42
|
| Rate for Payer: IEHP medi-cal |
$0.42
|
| Rate for Payer: IEHP medi-cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$3.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.88
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Prime Health Services Commercial |
$4.86
|
| Rate for Payer: Riverside University Health MISP |
$1.83
|
| Rate for Payer: Riverside University Health MISP |
$3.10
|
| Rate for Payer: Riverside University Health MISP |
$2.29
|
| Rate for Payer: Riverside University Health MISP |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO |
$3.88
|
| Rate for Payer: United Healthcare HMO Rider |
$2.86
|
| Rate for Payer: United Healthcare HMO Rider |
$2.28
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$6.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
|
|
ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION [15330]
|
Facility
IP
|
$5.11
|
|
|
Service Code
|
CPT J0153
|
| Hospital Charge Code |
1720905
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Blue Shield of California Commercial |
$3.83
|
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$4.14
|
| Rate for Payer: Blue Shield of California EPN |
$3.05
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.09
|
| Rate for Payer: Central Health Plan Commercial |
$3.66
|
| Rate for Payer: Central Health Plan Commercial |
$6.21
|
| Rate for Payer: Central Health Plan Commercial |
$4.58
|
| Rate for Payer: Cigna of CA HMO |
$5.43
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$4.00
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$4.00
|
| Rate for Payer: Cigna of CA PPO |
$5.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.83
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$3.88
|
| Rate for Payer: Galaxy Health WC |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4.66
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.43
|
| Rate for Payer: Global Benefits Group Commercial |
$2.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$3.88
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Prime Health Services Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.88
|
| Rate for Payer: Prime Health Services Commercial |
$4.86
|
|
|
Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 14301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,482.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,723.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,482.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,482.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,723.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,051.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,482.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,482.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,351.30
|
| Rate for Payer: IEHP medi-cal |
$7,396.12
|
| Rate for Payer: IEHP Medicare Advantage |
$4,482.50
|
| Rate for Payer: Innovage PACE Commercial |
$6,723.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,482.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,006.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,006.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,751.45
|
| Rate for Payer: Riverside University Health MISP |
$4,930.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,482.50
|
|
|
Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure)
|
Facility
OP
|
$5,779.00
|
|
|
Service Code
|
CPT 14302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 14061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 14060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 14041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less
|
Facility
OP
|
$7,027.00
|
|
|
Service Code
|
CPT 14040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 14021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 14020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 14001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less
|
Facility
OP
|
$7,027.00
|
|
|
Service Code
|
CPT 14000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES
|
Facility
IP
|
$3,475.72
|
|
|
Service Code
|
APR-DRG 7551
|
| Min. Negotiated Rate |
$2,916.68 |
| Max. Negotiated Rate |
$3,475.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,916.68
|
| Rate for Payer: IEHP medi-cal |
$3,475.72
|
|
|
ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES
|
Facility
IP
|
$13,772.07
|
|
|
Service Code
|
APR-DRG 7554
|
| Min. Negotiated Rate |
$11,556.98 |
| Max. Negotiated Rate |
$13,772.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,556.98
|
| Rate for Payer: IEHP medi-cal |
$13,772.07
|
|
|
ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES
|
Facility
IP
|
$7,988.55
|
|
|
Service Code
|
APR-DRG 7553
|
| Min. Negotiated Rate |
$6,703.68 |
| Max. Negotiated Rate |
$7,988.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,703.68
|
| Rate for Payer: IEHP medi-cal |
$7,988.55
|
|
|
ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES
|
Facility
IP
|
$5,096.12
|
|
|
Service Code
|
APR-DRG 7552
|
| Min. Negotiated Rate |
$4,276.46 |
| Max. Negotiated Rate |
$5,096.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,276.46
|
| Rate for Payer: IEHP medi-cal |
$5,096.12
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [200177]
|
Facility
OP
|
$4,490.48
|
|
|
Service Code
|
CPT J9354
|
| Hospital Charge Code |
ERX200177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$4,041.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$237.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$47.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.11
|
| Rate for Payer: BCBS Transplant Transplant |
$2,694.29
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$37.85
|
| Rate for Payer: Caremore Medicare Advantage |
$38.37
|
| Rate for Payer: Cash Price |
$2,020.72
|
| Rate for Payer: Cash Price |
$2,020.72
|
| Rate for Payer: Central Health Plan Commercial |
$3,592.38
|
| Rate for Payer: Cigna of CA HMO |
$3,143.34
|
| Rate for Payer: Cigna of CA PPO |
$3,143.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.37
|
| Rate for Payer: Galaxy Health WC |
$3,816.91
|
| Rate for Payer: Global Benefits Group Commercial |
$2,694.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,041.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,367.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$62.92
|
| Rate for Payer: IEHP medi-cal |
$63.31
|
| Rate for Payer: IEHP Medicare Advantage |
$38.37
|
| Rate for Payer: Innovage PACE Commercial |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,995.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$898.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.41
|
| Rate for Payer: Multiplan Commercial |
$3,367.86
|
| Rate for Payer: Networks By Design Commercial |
$2,245.24
|
| Rate for Payer: Prime Health Services Commercial |
$3,816.91
|
| Rate for Payer: Prime Health Services Medicare |
$40.67
|
| Rate for Payer: Riverside University Health MISP |
$42.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,694.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,694.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,245.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2,245.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2,245.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,245.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.20
|
| Rate for Payer: Vantage Medical Group Senior |
$38.37
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [200177]
|
Facility
IP
|
$4,490.48
|
|
|
Service Code
|
CPT J9354
|
| Hospital Charge Code |
ERX200177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$898.10 |
| Max. Negotiated Rate |
$4,041.43 |
| Rate for Payer: Blue Shield of California Commercial |
$3,367.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,397.92
|
| Rate for Payer: Cash Price |
$2,020.72
|
| Rate for Payer: Central Health Plan Commercial |
$3,592.38
|
| Rate for Payer: Cigna of CA HMO |
$3,143.34
|
| Rate for Payer: Cigna of CA PPO |
$3,143.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,796.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,796.19
|
| Rate for Payer: Galaxy Health WC |
$3,816.91
|
| Rate for Payer: Global Benefits Group Commercial |
$2,694.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,041.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,995.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$898.10
|
| Rate for Payer: Multiplan Commercial |
$3,367.86
|
| Rate for Payer: Networks By Design Commercial |
$2,245.24
|
| Rate for Payer: Prime Health Services Commercial |
$3,816.91
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION [200178]
|
Facility
IP
|
$7,184.76
|
|
|
Service Code
|
CPT J9354
|
| Hospital Charge Code |
ERX200178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,436.95 |
| Max. Negotiated Rate |
$6,466.28 |
| Rate for Payer: Blue Shield of California Commercial |
$5,388.57
|
| Rate for Payer: Blue Shield of California EPN |
$3,836.66
|
| Rate for Payer: Cash Price |
$3,233.14
|
| Rate for Payer: Central Health Plan Commercial |
$5,747.81
|
| Rate for Payer: Cigna of CA HMO |
$5,029.33
|
| Rate for Payer: Cigna of CA PPO |
$5,029.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,873.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,873.90
|
| Rate for Payer: Galaxy Health WC |
$6,107.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,310.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,466.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,792.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.95
|
| Rate for Payer: Multiplan Commercial |
$5,388.57
|
| Rate for Payer: Networks By Design Commercial |
$3,592.38
|
| Rate for Payer: Prime Health Services Commercial |
$6,107.05
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION [200178]
|
Facility
OP
|
$7,184.76
|
|
|
Service Code
|
CPT J9354
|
| Hospital Charge Code |
ERX200178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$6,466.28 |
| Rate for Payer: Adventist Health Medi-Cal |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$237.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$47.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.11
|
| Rate for Payer: BCBS Transplant Transplant |
$4,310.86
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$37.85
|
| Rate for Payer: Caremore Medicare Advantage |
$38.37
|
| Rate for Payer: Cash Price |
$3,233.14
|
| Rate for Payer: Cash Price |
$3,233.14
|
| Rate for Payer: Central Health Plan Commercial |
$5,747.81
|
| Rate for Payer: Cigna of CA HMO |
$5,029.33
|
| Rate for Payer: Cigna of CA PPO |
$5,029.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.37
|
| Rate for Payer: Galaxy Health WC |
$6,107.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,310.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,466.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,388.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$62.92
|
| Rate for Payer: IEHP medi-cal |
$63.31
|
| Rate for Payer: IEHP Medicare Advantage |
$38.37
|
| Rate for Payer: Innovage PACE Commercial |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,792.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.41
|
| Rate for Payer: Multiplan Commercial |
$5,388.57
|
| Rate for Payer: Networks By Design Commercial |
$3,592.38
|
| Rate for Payer: Prime Health Services Commercial |
$6,107.05
|
| Rate for Payer: Prime Health Services Medicare |
$40.67
|
| Rate for Payer: Riverside University Health MISP |
$42.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,310.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,310.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,592.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,592.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,592.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,592.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.20
|
| Rate for Payer: Vantage Medical Group Senior |
$38.37
|
|
|
ADRENAL PROCEDURES
|
Facility
IP
|
$27,201.12
|
|
|
Service Code
|
APR-DRG 4012
|
| Min. Negotiated Rate |
$22,826.11 |
| Max. Negotiated Rate |
$27,201.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,826.11
|
| Rate for Payer: IEHP medi-cal |
$27,201.12
|
|
|
ADRENAL PROCEDURES
|
Facility
IP
|
$15,436.52
|
|
|
Service Code
|
APR-DRG 4011
|
| Min. Negotiated Rate |
$12,953.72 |
| Max. Negotiated Rate |
$15,436.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,953.72
|
| Rate for Payer: IEHP medi-cal |
$15,436.52
|
|
|
ADRENAL PROCEDURES
|
Facility
IP
|
$34,135.20
|
|
|
Service Code
|
APR-DRG 4013
|
| Min. Negotiated Rate |
$28,644.92 |
| Max. Negotiated Rate |
$34,135.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$28,644.92
|
| Rate for Payer: IEHP medi-cal |
$34,135.20
|
|
