|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION [39477]
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$5.27
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$3.31
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$5.26
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$4.60
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$4.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$2.63
|
| Rate for Payer: Galaxy Health WC |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$4.93
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$3.29
|
| Rate for Payer: Prime Health Services Commercial |
$5.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION [39477]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.93
|
| 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 |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.26
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$4.60
|
| Rate for Payer: Cigna of CA PPO |
$4.60
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$2.63
|
| Rate for Payer: Galaxy Health WC |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.93
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$3.29
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$5.58
|
| Rate for Payer: Riverside University Health System MISP |
$2.63
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
ADENOSINE 6 MG/2 ML VIAL - CODE [4080560]
|
Facility
|
OP
|
$6.57
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Central Health Plan Commercial |
$5.26
|
| Rate for Payer: Cigna of CA HMO |
$4.60
|
| Rate for Payer: Cigna of CA PPO |
$4.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: EPIC Health Plan Senior |
$2.63
|
| Rate for Payer: Galaxy Health WC |
$5.58
|
| Rate for Payer: Global Benefits Group Commercial |
$3.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.93
|
| Rate for Payer: Networks By Design Commercial |
$3.29
|
| Rate for Payer: Prime Health Services Commercial |
$5.58
|
| Rate for Payer: Riverside University Health System MISP |
$2.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.58
|
|
|
ADENOSINE 6 MG/2 ML VIAL - CODE [4080560]
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$5.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.31
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Central Health Plan Commercial |
$5.26
|
| Rate for Payer: Cigna of CA HMO |
$4.60
|
| Rate for Payer: Cigna of CA PPO |
$4.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: EPIC Health Plan Senior |
$2.63
|
| Rate for Payer: Galaxy Health WC |
$5.58
|
| Rate for Payer: Global Benefits Group Commercial |
$3.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.93
|
| Rate for Payer: Networks By Design Commercial |
$3.29
|
| Rate for Payer: Prime Health Services Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
|
|
ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION [15330]
|
Facility
|
IP
|
$5.72
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.15 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6.22
|
| Rate for Payer: Blue Shield of California Commercial |
$5.73
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Blue Shield of California EPN |
$3.91
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Central Health Plan Commercial |
$6.21
|
| Rate for Payer: Central Health Plan Commercial |
$4.58
|
| Rate for Payer: Central Health Plan Commercial |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$5.72
|
| Rate for Payer: Cigna of CA HMO |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$5.43
|
| Rate for Payer: Cigna of CA HMO |
$2.69
|
| Rate for Payer: Cigna of CA PPO |
$2.69
|
| Rate for Payer: Cigna of CA PPO |
$4.00
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$2.29
|
| Rate for Payer: EPIC Health Plan Senior |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$3.10
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$6.08
|
| Rate for Payer: Galaxy Health WC |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4.66
|
| Rate for Payer: Global Benefits Group Commercial |
$3.43
|
| Rate for Payer: Global Benefits Group Commercial |
$4.29
|
| Rate for Payer: Global Benefits Group Commercial |
$2.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Networks By Design Commercial |
$3.88
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$3.58
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.08
|
| Rate for Payer: Prime Health Services Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.26
|
| Rate for Payer: Prime Health Services Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.61
|
| Rate for Payer: United Healthcare HMO Rider |
$1.37
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.77
|
| Rate for Payer: United Healthcare HMO Rider |
$2.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.34
|
|
|
ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION [15330]
|
Facility
|
OP
|
$7.76
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.36
|
| 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 |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cash Price |
$1.73
|
| 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 |
$3.49
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Central Health Plan Commercial |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$6.21
|
| Rate for Payer: Central Health Plan Commercial |
$5.72
|
| Rate for Payer: Central Health Plan Commercial |
$4.58
|
| Rate for Payer: Cigna of CA HMO |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$5.43
|
| Rate for Payer: Cigna of CA HMO |
$2.69
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.43
|
| Rate for Payer: Cigna of CA PPO |
$2.69
|
| Rate for Payer: Cigna of CA PPO |
$4.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| 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 |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$2.29
|
| Rate for Payer: EPIC Health Plan Senior |
$3.10
|
| Rate for Payer: Galaxy Health WC |
$6.60
|
| Rate for Payer: Galaxy Health WC |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$6.08
|
| Rate for Payer: Galaxy Health WC |
$3.26
|
| Rate for Payer: Global Benefits Group Commercial |
$4.66
|
| Rate for Payer: Global Benefits Group Commercial |
$3.43
|
| Rate for Payer: Global Benefits Group Commercial |
$4.29
|
| Rate for Payer: Global Benefits Group Commercial |
$2.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$3.88
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$3.58
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.08
|
| Rate for Payer: Prime Health Services Commercial |
$3.26
|
| Rate for Payer: Prime Health Services Commercial |
$4.86
|
| Rate for Payer: Riverside University Health System MISP |
$1.54
|
| Rate for Payer: Riverside University Health System MISP |
$2.29
|
| Rate for Payer: Riverside University Health System MISP |
$2.86
|
| Rate for Payer: Riverside University Health System MISP |
$3.10
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$2.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.61
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2.09
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1.37
|
| Rate for Payer: United Healthcare HMO Rider |
$2.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.86
|
| Rate for Payer: Vantage Medical Group Senior |
$6.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
| Rate for Payer: Vantage Medical Group Senior |
$6.08
|
| Rate for Payer: Vantage Medical Group Senior |
$3.26
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 14301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$305.45 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,557.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,557.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,411.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,013.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,557.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,013.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,474.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$305.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,380.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,107.48
|
| Rate for Payer: Multiplan WC |
$7,411.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Preferred Health Network WC |
$7,562.79
|
| Rate for Payer: Prime Health Services Medicare |
$4,831.29
|
| Rate for Payer: Prime Health Services WC |
$7,335.91
|
| Rate for Payer: Riverside University Health System MISP |
$5,013.60
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,557.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,557.82
|
|
|
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
|
$27,467.00
|
|
|
Service Code
|
CPT 14302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$325.94 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$325.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.05
|
| 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
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 14061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,274.31 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,274.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,407.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 14060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$145.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
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
|
$27,467.00
|
|
|
Service Code
|
CPT 14041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$725.53 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$725.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 14040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$115.91 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 14021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$580.16 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$580.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 14001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$502.03 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$502.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$554.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 14000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.85 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$76.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$4,143.20
|
|
|
Service Code
|
APR-DRG 7551
|
| Min. Negotiated Rate |
$2,616.76 |
| Max. Negotiated Rate |
$4,143.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,616.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,118.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,143.20
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$5,579.31
|
|
|
Service Code
|
APR-DRG 7552
|
| Min. Negotiated Rate |
$3,523.78 |
| Max. Negotiated Rate |
$5,579.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,523.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,199.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,579.31
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$10,340.84
|
|
|
Service Code
|
APR-DRG 7553
|
| Min. Negotiated Rate |
$6,531.06 |
| Max. Negotiated Rate |
$10,340.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,531.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,782.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,340.84
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$16,413.62
|
|
|
Service Code
|
APR-DRG 7554
|
| Min. Negotiated Rate |
$10,366.50 |
| Max. Negotiated Rate |
$16,413.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,366.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,353.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,413.62
|
|
|
ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEM REQUIRING ANESTHESIA (EG, NEW PIN[S] OR WIRE[S] AND/OR NEW RING[S] OR BAR[S])
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 20693
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.11 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| 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 |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$484.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$534.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
ADJUVANT AS01B (PF), COMPONENT VIAL 1 OF 2 INTRAMUSCULAR SUSPENSION [219987]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 5816082903
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
ADJUVANT AS01B (PF), COMPONENT VIAL 1 OF 2 INTRAMUSCULAR SUSPENSION [219987]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 5816082903
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [200177]
|
Facility
|
OP
|
$4,979.06
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.63 |
| Max. Negotiated Rate |
$4,481.15 |
| Rate for Payer: Adventist Health Commercial |
$995.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$43.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$254.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.51
|
| Rate for Payer: Blue Shield of California Commercial |
$51.89
|
| Rate for Payer: Blue Shield of California EPN |
$47.17
|
| Rate for Payer: Cash Price |
$2,240.58
|
| Rate for Payer: Cash Price |
$2,240.58
|
| Rate for Payer: Central Health Plan Commercial |
$3,983.25
|
| Rate for Payer: Cigna of CA HMO |
$3,485.34
|
| Rate for Payer: Cigna of CA PPO |
$3,485.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,485.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.99
|
| Rate for Payer: EPIC Health Plan Senior |
$47.99
|
| Rate for Payer: Galaxy Health WC |
$4,232.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,987.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,481.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$71.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,161.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$995.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$58.46
|
| Rate for Payer: Multiplan Commercial |
$3,734.30
|
| Rate for Payer: Networks By Design Commercial |
$2,489.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$43.63
|
| Rate for Payer: Prime Health Services Commercial |
$4,232.20
|
| Rate for Payer: Prime Health Services Medicare |
$46.25
|
| Rate for Payer: Riverside University Health System MISP |
$47.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,987.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,987.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,818.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$43.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.99
|
| Rate for Payer: Vantage Medical Group Senior |
$47.99
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [200177]
|
Facility
|
IP
|
$4,979.06
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$995.81 |
| Max. Negotiated Rate |
$4,481.15 |
| Rate for Payer: Adventist Health Commercial |
$995.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3,993.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,509.45
|
| Rate for Payer: Cash Price |
$2,240.58
|
| Rate for Payer: Central Health Plan Commercial |
$3,983.25
|
| Rate for Payer: Cigna of CA HMO |
$3,485.34
|
| Rate for Payer: Cigna of CA PPO |
$3,485.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,485.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,991.62
|
| Rate for Payer: EPIC Health Plan Senior |
$1,991.62
|
| Rate for Payer: Galaxy Health WC |
$4,232.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,987.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,481.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,161.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,937.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$995.81
|
| Rate for Payer: Multiplan Commercial |
$3,734.30
|
| Rate for Payer: Networks By Design Commercial |
$2,489.53
|
| Rate for Payer: Prime Health Services Commercial |
$4,232.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,818.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.64
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION [200178]
|
Facility
|
OP
|
$7,966.49
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.63 |
| Max. Negotiated Rate |
$7,169.84 |
| Rate for Payer: Adventist Health Commercial |
$1,593.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$43.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$254.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.51
|
| Rate for Payer: Blue Shield of California Commercial |
$51.89
|
| Rate for Payer: Blue Shield of California EPN |
$47.17
|
| Rate for Payer: Cash Price |
$3,584.92
|
| Rate for Payer: Cash Price |
$3,584.92
|
| Rate for Payer: Central Health Plan Commercial |
$6,373.19
|
| Rate for Payer: Cigna of CA HMO |
$5,576.54
|
| Rate for Payer: Cigna of CA PPO |
$5,576.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,576.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.99
|
| Rate for Payer: EPIC Health Plan Senior |
$47.99
|
| Rate for Payer: Galaxy Health WC |
$6,771.52
|
| Rate for Payer: Global Benefits Group Commercial |
$4,779.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,169.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$71.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,058.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,593.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$58.46
|
| Rate for Payer: Multiplan Commercial |
$5,974.87
|
| Rate for Payer: Networks By Design Commercial |
$3,983.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$43.63
|
| Rate for Payer: Prime Health Services Commercial |
$6,771.52
|
| Rate for Payer: Prime Health Services Medicare |
$46.25
|
| Rate for Payer: Riverside University Health System MISP |
$47.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,779.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,779.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,989.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2,910.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2,847.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,609.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$43.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.99
|
| Rate for Payer: Vantage Medical Group Senior |
$47.99
|
|
