|
KIT FOR TC 99M-LABELED RED BLOOD CELLS INTRAVENOUS SOLUTION [225270]
|
Facility
|
IP
|
$181.13
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$36.23 |
| Max. Negotiated Rate |
$163.02 |
| Rate for Payer: Adventist Health Commercial |
$36.23
|
| Rate for Payer: Blue Shield of California Commercial |
$145.27
|
| Rate for Payer: Blue Shield of California EPN |
$91.29
|
| Rate for Payer: Cash Price |
$81.51
|
| Rate for Payer: Central Health Plan Commercial |
$144.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.45
|
| Rate for Payer: EPIC Health Plan Senior |
$72.45
|
| Rate for Payer: Galaxy Health WC |
$153.96
|
| Rate for Payer: Global Benefits Group Commercial |
$108.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.23
|
| Rate for Payer: Multiplan Commercial |
$135.85
|
| Rate for Payer: Networks By Design Commercial |
$117.73
|
| Rate for Payer: Prime Health Services Commercial |
$153.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.98
|
| Rate for Payer: United Healthcare All Other HMO |
$66.17
|
| Rate for Payer: United Healthcare HMO Rider |
$64.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.32
|
|
|
KIT FOR THE PREPARATION OF GA-68-DOTATATE 40 MCG INTRAVENOUS SOLN [215477]
|
Facility
|
OP
|
$3,931.20
|
|
|
Service Code
|
HCPCS A9587
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$3,538.08 |
| Rate for Payer: Adventist Health Commercial |
$786.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,476.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,560.69
|
| Rate for Payer: Cash Price |
$1,769.04
|
| Rate for Payer: Cash Price |
$1,769.04
|
| Rate for Payer: Central Health Plan Commercial |
$3,144.96
|
| Rate for Payer: Cigna of CA HMO |
$2,515.97
|
| Rate for Payer: Cigna of CA PPO |
$2,909.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,751.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.89
|
| Rate for Payer: EPIC Health Plan Senior |
$54.59
|
| Rate for Payer: Galaxy Health WC |
$3,341.52
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,538.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,496.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$66.50
|
| Rate for Payer: Multiplan Commercial |
$2,948.40
|
| Rate for Payer: Networks By Design Commercial |
$2,555.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.63
|
| Rate for Payer: Prime Health Services Commercial |
$3,341.52
|
| Rate for Payer: Prime Health Services Medicare |
$52.61
|
| Rate for Payer: Riverside University Health System MISP |
$54.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,358.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,475.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,436.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,405.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,287.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.59
|
| Rate for Payer: Vantage Medical Group Senior |
$54.59
|
|
|
KIT FOR THE PREPARATION OF GA-68-DOTATATE 40 MCG INTRAVENOUS SOLN [215477]
|
Facility
|
IP
|
$3,931.20
|
|
|
Service Code
|
HCPCS A9587
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$786.24 |
| Max. Negotiated Rate |
$3,538.08 |
| Rate for Payer: Adventist Health Commercial |
$786.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3,152.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,981.32
|
| Rate for Payer: Cash Price |
$1,769.04
|
| Rate for Payer: Central Health Plan Commercial |
$3,144.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,751.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,572.48
|
| Rate for Payer: Galaxy Health WC |
$3,341.52
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,538.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,496.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,319.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.24
|
| Rate for Payer: Multiplan Commercial |
$2,948.40
|
| Rate for Payer: Networks By Design Commercial |
$2,555.28
|
| Rate for Payer: Prime Health Services Commercial |
$3,341.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,475.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,436.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,405.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,287.47
|
|
|
KIT FOR THE PREPARATION OF TC-99M-MEBROFENIN 45 MG IV SOLUTION [121131]
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$72.18
|
| Rate for Payer: Blue Shield of California EPN |
$45.36
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
|
|
KIT FOR THE PREPARATION OF TC-99M-MEBROFENIN 45 MG IV SOLUTION [121131]
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.16
|
| Rate for Payer: Blue Shield of California Commercial |
$56.70
|
| Rate for Payer: Blue Shield of California EPN |
$35.73
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Riverside University Health System MISP |
$36.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
KIT FOR THE PREPARATION OF TC-99M-TETROFOSMIN 0.23 MG IV SOLUTION [98467]
|
Facility
|
IP
|
$127.60
|
|
|
Service Code
|
HCPCS A9502
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$114.84 |
| Rate for Payer: Adventist Health Commercial |
$25.52
|
| Rate for Payer: Blue Shield of California Commercial |
$102.34
|
| Rate for Payer: Blue Shield of California EPN |
$64.31
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Central Health Plan Commercial |
$102.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.04
|
| Rate for Payer: EPIC Health Plan Senior |
$51.04
|
| Rate for Payer: Galaxy Health WC |
$108.46
|
| Rate for Payer: Global Benefits Group Commercial |
$76.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.52
|
| Rate for Payer: Multiplan Commercial |
$95.70
|
| Rate for Payer: Networks By Design Commercial |
$82.94
|
| Rate for Payer: Prime Health Services Commercial |
$108.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.89
|
| Rate for Payer: United Healthcare All Other HMO |
$46.61
|
| Rate for Payer: United Healthcare HMO Rider |
$45.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.79
|
|
|
KIT FOR THE PREPARATION OF TC-99M-TETROFOSMIN 0.23 MG IV SOLUTION [98467]
|
Facility
|
OP
|
$127.60
|
|
|
Service Code
|
HCPCS A9502
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$259.32 |
| Rate for Payer: Adventist Health Commercial |
$25.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.32
|
| Rate for Payer: Blue Shield of California Commercial |
$80.39
|
| Rate for Payer: Blue Shield of California EPN |
$50.66
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Central Health Plan Commercial |
$102.08
|
| Rate for Payer: Cigna of CA HMO |
$81.66
|
| Rate for Payer: Cigna of CA PPO |
$94.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.04
|
| Rate for Payer: EPIC Health Plan Senior |
$51.04
|
| Rate for Payer: Galaxy Health WC |
$108.46
|
| Rate for Payer: Global Benefits Group Commercial |
$76.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$166.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.32
|
| Rate for Payer: Multiplan Commercial |
$95.70
|
| Rate for Payer: Networks By Design Commercial |
$82.94
|
| Rate for Payer: Prime Health Services Commercial |
$108.46
|
| Rate for Payer: Riverside University Health System MISP |
$51.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.89
|
| Rate for Payer: United Healthcare All Other HMO |
$46.61
|
| Rate for Payer: United Healthcare HMO Rider |
$45.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.46
|
| Rate for Payer: Vantage Medical Group Senior |
$108.46
|
|
|
KIT FOR THE PREP OF TC-99M-TILMANOCEPT 250 MCG SOLUTION FOR INJECTION [223025]
|
Facility
|
IP
|
$755.82
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$151.16 |
| Max. Negotiated Rate |
$680.24 |
| Rate for Payer: Adventist Health Commercial |
$151.16
|
| Rate for Payer: Blue Shield of California Commercial |
$606.17
|
| Rate for Payer: Blue Shield of California EPN |
$380.93
|
| Rate for Payer: Cash Price |
$340.12
|
| Rate for Payer: Central Health Plan Commercial |
$604.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.33
|
| Rate for Payer: EPIC Health Plan Senior |
$302.33
|
| Rate for Payer: Galaxy Health WC |
$642.45
|
| Rate for Payer: Global Benefits Group Commercial |
$453.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$680.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$479.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$445.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.16
|
| Rate for Payer: Multiplan Commercial |
$566.87
|
| Rate for Payer: Networks By Design Commercial |
$491.28
|
| Rate for Payer: Prime Health Services Commercial |
$642.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.66
|
| Rate for Payer: United Healthcare All Other HMO |
$276.10
|
| Rate for Payer: United Healthcare HMO Rider |
$270.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.53
|
|
|
KIT FOR THE PREP OF TC-99M-TILMANOCEPT 250 MCG SOLUTION FOR INJECTION [223025]
|
Facility
|
OP
|
$755.82
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$151.16 |
| Max. Negotiated Rate |
$680.24 |
| Rate for Payer: Adventist Health Commercial |
$151.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$642.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$415.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$566.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$559.19
|
| Rate for Payer: Blue Shield of California Commercial |
$476.17
|
| Rate for Payer: Blue Shield of California EPN |
$300.06
|
| Rate for Payer: Cash Price |
$340.12
|
| Rate for Payer: Cash Price |
$340.12
|
| Rate for Payer: Central Health Plan Commercial |
$604.66
|
| Rate for Payer: Cigna of CA HMO |
$483.72
|
| Rate for Payer: Cigna of CA PPO |
$559.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$642.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$642.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$642.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.33
|
| Rate for Payer: EPIC Health Plan Senior |
$302.33
|
| Rate for Payer: Galaxy Health WC |
$642.45
|
| Rate for Payer: Global Benefits Group Commercial |
$453.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$680.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$479.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$445.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.07
|
| Rate for Payer: Multiplan Commercial |
$566.87
|
| Rate for Payer: Networks By Design Commercial |
$491.28
|
| Rate for Payer: Prime Health Services Commercial |
$642.45
|
| Rate for Payer: Riverside University Health System MISP |
$302.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.66
|
| Rate for Payer: United Healthcare All Other HMO |
$276.10
|
| Rate for Payer: United Healthcare HMO Rider |
$270.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$642.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$642.45
|
| Rate for Payer: Vantage Medical Group Senior |
$642.45
|
|
|
KIT OSTOMY SENSURA FLEX
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$12.39 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
KIT OSTOMY SENSURA FLEX
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
KIT PREPARATION OF TC 99M-SESTAMIBI COMBO NO.1 IV SOLUTION [121547]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.87
|
| Rate for Payer: Blue Shield of California EPN |
$18.14
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
|
|
KIT PREPARATION OF TC 99M-SESTAMIBI COMBO NO.1 IV SOLUTION [121547]
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$263.65 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$211.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.65
|
| Rate for Payer: Blue Shield of California Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$167.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
KIT PREPARATION OF TC-99M-SODIUM PYROPHOSPHATE 12 MG IV SOLUTION [121139]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS A9538
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$121.69 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.48
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California EPN |
$23.82
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Riverside University Health System MISP |
$24.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
KIT PREPARATION OF TC-99M-SODIUM PYROPHOSPHATE 12 MG IV SOLUTION [121139]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS A9538
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$48.12
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$21,636.42
|
|
|
Service Code
|
APR-DRG 3131
|
| Min. Negotiated Rate |
$13,665.11 |
| Max. Negotiated Rate |
$21,636.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,665.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,284.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,636.42
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$28,790.83
|
|
|
Service Code
|
APR-DRG 3132
|
| Min. Negotiated Rate |
$18,183.68 |
| Max. Negotiated Rate |
$28,790.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,183.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,668.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,790.83
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$62,198.19
|
|
|
Service Code
|
APR-DRG 3134
|
| Min. Negotiated Rate |
$39,283.07 |
| Max. Negotiated Rate |
$62,198.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$39,283.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46,812.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62,198.19
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$40,493.28
|
|
|
Service Code
|
APR-DRG 3133
|
| Min. Negotiated Rate |
$25,574.70 |
| Max. Negotiated Rate |
$40,493.28 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,574.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30,476.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,493.28
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC
|
Facility
|
IP
|
$41,742.28
|
|
|
Service Code
|
MSDRG 488
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$41,742.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,099.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,902.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,264.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,742.28
|
| Rate for Payer: EPIC Health Plan Senior |
$27,828.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,298.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,417.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,899.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,298.35
|
| Rate for Payer: Prime Health Services Medicare |
$26,816.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$29,393.06
|
|
|
Service Code
|
MSDRG 489
|
| Min. Negotiated Rate |
$7,611.00 |
| 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: 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 |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC
|
Facility
|
IP
|
$55,035.66
|
|
|
Service Code
|
MSDRG 486
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$55,035.66 |
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55,035.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35,550.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49,772.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,074.53
|
| Rate for Payer: EPIC Health Plan Senior |
$32,716.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,742.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41,639.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39,854.47
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29,742.14
|
| Rate for Payer: Prime Health Services Medicare |
$31,526.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC
|
Facility
|
IP
|
$84,934.04
|
|
|
Service Code
|
MSDRG 485
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$84,934.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84,934.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54,863.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76,811.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$74,926.38
|
| Rate for Payer: EPIC Health Plan Senior |
$49,950.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$45,409.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63,573.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60,849.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$45,409.93
|
| Rate for Payer: Prime Health Services Medicare |
$48,134.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$41,220.82
|
|
|
Service Code
|
MSDRG 487
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$41,220.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,220.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,626.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,278.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,129.49
|
| Rate for Payer: EPIC Health Plan Senior |
$24,752.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,502.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,503.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,153.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,502.72
|
| Rate for Payer: Prime Health Services Medicare |
$23,852.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
K-PHOS NEUTRAL ORAL SUSP CMPD 25 MG/ML (0.1 MEQ/ML) [4080284]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 9994080284
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
