|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$29,393.06
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$29,393.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,393.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18,986.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,582.07
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,902.49
|
| Rate for Payer: EPIC Health Plan Senior |
$17,934.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,304.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,826.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,848.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,304.54
|
| Rate for Payer: Prime Health Services Medicare |
$17,282.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,817.00
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$43,413.19
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$43,413.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,413.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28,043.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39,261.40
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,025.11
|
| Rate for Payer: EPIC Health Plan Senior |
$26,016.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,651.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,112.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,693.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,651.58
|
| Rate for Payer: Prime Health Services Medicare |
$25,070.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,817.00
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$25,234.66
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$25,234.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,234.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,300.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,821.36
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,306.93
|
| Rate for Payer: EPIC Health Plan Senior |
$15,537.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,125.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,775.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,928.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,125.41
|
| Rate for Payer: Prime Health Services Medicare |
$14,972.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,817.00
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$22,530.52
|
|
|
Service Code
|
APR-DRG 5393
|
| Min. Negotiated Rate |
$14,229.80 |
| Max. Negotiated Rate |
$22,530.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,229.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,957.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,530.52
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$12,881.54
|
|
|
Service Code
|
APR-DRG 5392
|
| Min. Negotiated Rate |
$8,135.71 |
| Max. Negotiated Rate |
$12,881.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,135.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,695.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,881.54
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$10,470.98
|
|
|
Service Code
|
APR-DRG 5391
|
| Min. Negotiated Rate |
$6,613.25 |
| Max. Negotiated Rate |
$10,470.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,613.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,880.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,470.98
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$46,240.66
|
|
|
Service Code
|
APR-DRG 5394
|
| Min. Negotiated Rate |
$29,204.63 |
| Max. Negotiated Rate |
$46,240.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$29,204.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34,802.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46,240.66
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$27,900.77
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$27,900.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,900.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18,022.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,232.50
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,612.17
|
| Rate for Payer: EPIC Health Plan Senior |
$17,074.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,522.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,731.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,800.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15,522.53
|
| Rate for Payer: Prime Health Services Medicare |
$16,453.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,817.00
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$64,615.78
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$64,615.78 |
| Rate for Payer: United Healthcare HMO Rider |
$10,716.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64,615.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41,739.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58,436.29
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,358.04
|
| Rate for Payer: EPIC Health Plan Senior |
$38,238.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,762.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48,667.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46,581.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$34,762.45
|
| Rate for Payer: Prime Health Services Medicare |
$36,848.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,305.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,817.00
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$25,208.34
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$25,208.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,283.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,797.56
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,284.16
|
| Rate for Payer: EPIC Health Plan Senior |
$15,522.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,111.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,756.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,909.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,111.61
|
| Rate for Payer: Prime Health Services Medicare |
$14,958.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,817.00
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 4580297426
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 4580297426
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$152.69 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$81.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.58
|
| Rate for Payer: Blue Shield of California Commercial |
$106.14
|
| Rate for Payer: Blue Shield of California EPN |
$96.49
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Central Health Plan Commercial |
$16.30
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$14.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.76
|
| Rate for Payer: EPIC Health Plan Senior |
$89.84
|
| Rate for Payer: Galaxy Health WC |
$17.32
|
| Rate for Payer: Global Benefits Group Commercial |
$12.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$133.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$81.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.44
|
| Rate for Payer: Multiplan Commercial |
$15.29
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$81.67
|
| Rate for Payer: Prime Health Services Commercial |
$17.32
|
| Rate for Payer: Prime Health Services Medicare |
$86.57
|
| Rate for Payer: Riverside University Health System MISP |
$89.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.44
|
| Rate for Payer: United Healthcare HMO Rider |
$7.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$81.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Vantage Medical Group Senior |
$89.84
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California Commercial |
$16.34
|
| Rate for Payer: Blue Shield of California EPN |
$10.27
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Central Health Plan Commercial |
$16.30
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$14.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.15
|
| Rate for Payer: EPIC Health Plan Senior |
$8.15
|
| Rate for Payer: Galaxy Health WC |
$17.32
|
| Rate for Payer: Global Benefits Group Commercial |
$12.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$15.29
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: Prime Health Services Commercial |
$17.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.44
|
| Rate for Payer: United Healthcare HMO Rider |
$7.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.67
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California Commercial |
$16.34
|
| Rate for Payer: Blue Shield of California EPN |
$10.27
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Central Health Plan Commercial |
$16.30
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$14.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.15
|
| Rate for Payer: EPIC Health Plan Senior |
$8.15
|
| Rate for Payer: Galaxy Health WC |
$17.32
|
| Rate for Payer: Global Benefits Group Commercial |
$12.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$15.29
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: Prime Health Services Commercial |
$17.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.44
|
| Rate for Payer: United Healthcare HMO Rider |
$7.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.67
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$152.69 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$81.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.58
|
| Rate for Payer: Blue Shield of California Commercial |
$106.14
|
| Rate for Payer: Blue Shield of California EPN |
$96.49
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Central Health Plan Commercial |
$16.30
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$14.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.76
|
| Rate for Payer: EPIC Health Plan Senior |
$89.84
|
| Rate for Payer: Galaxy Health WC |
$17.32
|
| Rate for Payer: Global Benefits Group Commercial |
$12.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$133.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$81.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.44
|
| Rate for Payer: Multiplan Commercial |
$15.29
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$81.67
|
| Rate for Payer: Prime Health Services Commercial |
$17.32
|
| Rate for Payer: Prime Health Services Medicare |
$86.57
|
| Rate for Payer: Riverside University Health System MISP |
$89.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.44
|
| Rate for Payer: United Healthcare HMO Rider |
$7.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$81.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Vantage Medical Group Senior |
$89.84
|
|
|
CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 51710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$180.58 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$896.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,351.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.79
|
| Rate for Payer: EPIC Health Plan Senior |
$986.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,470.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$180.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,255.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,201.77
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$896.84
|
| Rate for Payer: Preferred Health Network WC |
$1,378.84
|
| Rate for Payer: Prime Health Services Medicare |
$950.65
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$986.52
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$896.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$101.17 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$321.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (IE, PROUD FLESH)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 17250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
CHEMODENERVATION OF ECCRINE GLANDS; BOTH AXILLAE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$87.74 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 46505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$325.30 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,387.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$325.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$359.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Preferred Health Network WC |
$2,435.74
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| 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 |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL, TRIGEMINAL, CERVICAL SPINAL AND ACCESSORY NERVES, BILATERAL (EG, FOR CHRONIC MIGRAINE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.66 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
CHEMODENERVATION OF MUSCLE(S); NECK MUSCLE(S), EXCLUDING MUSCLES OF THE LARYNX, UNILATERAL (EG, FOR CERVICAL DYSTONIA, SPASMODIC TORTICOLLIS)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64616
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$155.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$171.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
CHEMODENERVATION OF ONE EXTREMITY; 1-4 MUSCLE(S)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$156.88 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$907.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$156.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
CHEMODENERVATION OF ONE EXTREMITY; 5 OR MORE MUSCLES
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64644
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$907.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
