|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$40,757.60
|
|
|
Service Code
|
MSDRG 945
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$40,757.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,757.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,327.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,859.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,728.92
|
| Rate for Payer: EPIC Health Plan Senior |
$24,485.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,259.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,163.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,828.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,259.95
|
| Rate for Payer: Prime Health Services Medicare |
$23,595.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$30,182.63
|
|
|
Service Code
|
MSDRG 946
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$30,182.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,182.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,496.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,296.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,585.24
|
| Rate for Payer: EPIC Health Plan Senior |
$18,390.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,718.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,405.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,402.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,718.33
|
| Rate for Payer: Prime Health Services Medicare |
$17,721.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
RELEASE OF THENAR MUSCLE(S) (EG, THUMB CONTRACTURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 26508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$601.93 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$6,568.63
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$601.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
IP
|
$113.81
|
|
|
Service Code
|
NDC 7297412001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$102.43 |
| Rate for Payer: Adventist Health Commercial |
$22.76
|
| Rate for Payer: Blue Shield of California Commercial |
$91.28
|
| Rate for Payer: Blue Shield of California EPN |
$57.36
|
| Rate for Payer: Cash Price |
$51.21
|
| Rate for Payer: Central Health Plan Commercial |
$91.05
|
| Rate for Payer: Cigna of CA HMO |
$79.67
|
| Rate for Payer: Cigna of CA PPO |
$79.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.52
|
| Rate for Payer: EPIC Health Plan Senior |
$45.52
|
| Rate for Payer: Galaxy Health WC |
$96.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.76
|
| Rate for Payer: Multiplan Commercial |
$85.36
|
| Rate for Payer: Networks By Design Commercial |
$73.98
|
| Rate for Payer: Prime Health Services Commercial |
$96.74
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
OP
|
$113.81
|
|
|
Service Code
|
NDC 7297412001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$102.43 |
| Rate for Payer: Adventist Health Commercial |
$22.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.20
|
| Rate for Payer: Blue Shield of California Commercial |
$72.16
|
| Rate for Payer: Blue Shield of California EPN |
$45.41
|
| Rate for Payer: Cash Price |
$51.21
|
| Rate for Payer: Central Health Plan Commercial |
$91.05
|
| Rate for Payer: Cigna of CA HMO |
$79.67
|
| Rate for Payer: Cigna of CA PPO |
$79.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.52
|
| Rate for Payer: EPIC Health Plan Senior |
$45.52
|
| Rate for Payer: Galaxy Health WC |
$96.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.67
|
| Rate for Payer: Multiplan Commercial |
$85.36
|
| Rate for Payer: Networks By Design Commercial |
$73.98
|
| Rate for Payer: Prime Health Services Commercial |
$96.74
|
| Rate for Payer: Riverside University Health System MISP |
$45.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.91
|
| Rate for Payer: United Healthcare All Other HMO |
$56.91
|
| Rate for Payer: United Healthcare HMO Rider |
$56.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.74
|
| Rate for Payer: Vantage Medical Group Senior |
$96.74
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]
|
Facility
|
IP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.07 |
| Max. Negotiated Rate |
$765.32 |
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Blue Shield of California Commercial |
$681.99
|
| Rate for Payer: Blue Shield of California EPN |
$428.58
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Central Health Plan Commercial |
$680.29
|
| Rate for Payer: Cigna of CA HMO |
$595.25
|
| Rate for Payer: Cigna of CA PPO |
$595.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.14
|
| Rate for Payer: EPIC Health Plan Senior |
$340.14
|
| Rate for Payer: Galaxy Health WC |
$722.81
|
| Rate for Payer: Global Benefits Group Commercial |
$510.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.07
|
| Rate for Payer: Multiplan Commercial |
$637.77
|
| Rate for Payer: Networks By Design Commercial |
$425.18
|
| Rate for Payer: Prime Health Services Commercial |
$722.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.14
|
| Rate for Payer: United Healthcare All Other HMO |
$310.64
|
| Rate for Payer: United Healthcare HMO Rider |
$303.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.49
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]
|
Facility
|
OP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$765.32 |
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.81
|
| Rate for Payer: Blue Shield of California Commercial |
$7.91
|
| Rate for Payer: Blue Shield of California EPN |
$7.19
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Central Health Plan Commercial |
$680.29
|
| Rate for Payer: Cigna of CA HMO |
$595.25
|
| Rate for Payer: Cigna of CA PPO |
$595.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.39
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$722.81
|
| Rate for Payer: Global Benefits Group Commercial |
$510.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.06
|
| Rate for Payer: Multiplan Commercial |
$637.77
|
| Rate for Payer: Networks By Design Commercial |
$425.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.51
|
| Rate for Payer: Prime Health Services Commercial |
$722.81
|
| Rate for Payer: Prime Health Services Medicare |
$7.96
|
| Rate for Payer: Riverside University Health System MISP |
$8.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.14
|
| Rate for Payer: United Healthcare All Other HMO |
$310.64
|
| Rate for Payer: United Healthcare HMO Rider |
$303.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8.26
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
IP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.07 |
| Max. Negotiated Rate |
$765.32 |
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Blue Shield of California Commercial |
$681.99
|
| Rate for Payer: Blue Shield of California EPN |
$428.58
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Central Health Plan Commercial |
$680.29
|
| Rate for Payer: Cigna of CA HMO |
$595.25
|
| Rate for Payer: Cigna of CA PPO |
$595.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.14
|
| Rate for Payer: EPIC Health Plan Senior |
$340.14
|
| Rate for Payer: Galaxy Health WC |
$722.81
|
| Rate for Payer: Global Benefits Group Commercial |
$510.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.07
|
| Rate for Payer: Multiplan Commercial |
$637.77
|
| Rate for Payer: Networks By Design Commercial |
$425.18
|
| Rate for Payer: Prime Health Services Commercial |
$722.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.14
|
| Rate for Payer: United Healthcare All Other HMO |
$310.64
|
| Rate for Payer: United Healthcare HMO Rider |
$303.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.49
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
OP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$765.32 |
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.81
|
| Rate for Payer: Blue Shield of California Commercial |
$7.91
|
| Rate for Payer: Blue Shield of California EPN |
$7.19
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Central Health Plan Commercial |
$680.29
|
| Rate for Payer: Cigna of CA HMO |
$595.25
|
| Rate for Payer: Cigna of CA PPO |
$595.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.39
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$722.81
|
| Rate for Payer: Global Benefits Group Commercial |
$510.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.06
|
| Rate for Payer: Multiplan Commercial |
$637.77
|
| Rate for Payer: Networks By Design Commercial |
$425.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.51
|
| Rate for Payer: Prime Health Services Commercial |
$722.81
|
| Rate for Payer: Prime Health Services Medicare |
$7.96
|
| Rate for Payer: Riverside University Health System MISP |
$8.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.14
|
| Rate for Payer: United Healthcare All Other HMO |
$310.64
|
| Rate for Payer: United Healthcare HMO Rider |
$303.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8.26
|
|
|
REMESTEMCEL-L-RKND 6.68 X 10EXP6 CELL/ML INTRAVENOUS SUSPENSION [245044]
|
Facility
|
OP
|
$232,800.00
|
|
|
Service Code
|
HCPCS J3402
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46,560.00 |
| Max. Negotiated Rate |
$336,038.60 |
| Rate for Payer: Adventist Health Commercial |
$46,560.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$203,659.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141,379.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305,489.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224,025.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$203,659.76
|
| Rate for Payer: Blue Shield of California Commercial |
$147,595.20
|
| Rate for Payer: Blue Shield of California EPN |
$92,887.20
|
| Rate for Payer: Cash Price |
$104,760.00
|
| Rate for Payer: Cash Price |
$104,760.00
|
| Rate for Payer: Central Health Plan Commercial |
$186,240.00
|
| Rate for Payer: Cigna of CA HMO |
$162,960.00
|
| Rate for Payer: Cigna of CA PPO |
$162,960.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305,489.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$224,025.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$203,659.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162,960.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336,038.60
|
| Rate for Payer: EPIC Health Plan Senior |
$224,025.74
|
| Rate for Payer: Galaxy Health WC |
$197,880.00
|
| Rate for Payer: Global Benefits Group Commercial |
$139,680.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$209,520.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334,002.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203,659.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$203,659.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147,828.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127,723.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$285,123.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46,560.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$272,904.08
|
| Rate for Payer: Multiplan Commercial |
$174,600.00
|
| Rate for Payer: Networks By Design Commercial |
$116,400.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$203,659.76
|
| Rate for Payer: Prime Health Services Commercial |
$197,880.00
|
| Rate for Payer: Prime Health Services Medicare |
$215,879.35
|
| Rate for Payer: Riverside University Health System MISP |
$224,025.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139,680.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139,680.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$87,369.84
|
| Rate for Payer: United Healthcare All Other HMO |
$85,041.84
|
| Rate for Payer: United Healthcare HMO Rider |
$83,202.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76,242.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$203,659.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305,489.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224,025.74
|
| Rate for Payer: Vantage Medical Group Senior |
$203,659.76
|
|
|
REMESTEMCEL-L-RKND 6.68 X 10EXP6 CELL/ML INTRAVENOUS SUSPENSION [245044]
|
Facility
|
IP
|
$232,800.00
|
|
|
Service Code
|
HCPCS J3402
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46,560.00 |
| Max. Negotiated Rate |
$209,520.00 |
| Rate for Payer: Adventist Health Commercial |
$46,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$186,705.60
|
| Rate for Payer: Blue Shield of California EPN |
$117,331.20
|
| Rate for Payer: Cash Price |
$104,760.00
|
| Rate for Payer: Central Health Plan Commercial |
$186,240.00
|
| Rate for Payer: Cigna of CA HMO |
$162,960.00
|
| Rate for Payer: Cigna of CA PPO |
$162,960.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162,960.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$93,120.00
|
| Rate for Payer: Galaxy Health WC |
$197,880.00
|
| Rate for Payer: Global Benefits Group Commercial |
$139,680.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$209,520.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147,828.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137,352.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46,560.00
|
| Rate for Payer: Multiplan Commercial |
$174,600.00
|
| Rate for Payer: Networks By Design Commercial |
$116,400.00
|
| Rate for Payer: Prime Health Services Commercial |
$197,880.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$87,369.84
|
| Rate for Payer: United Healthcare All Other HMO |
$85,041.84
|
| Rate for Payer: United Healthcare HMO Rider |
$83,202.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76,242.00
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$87.97
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$79.17 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.98
|
| Rate for Payer: Blue Shield of California Commercial |
$55.77
|
| Rate for Payer: Blue Shield of California Commercial |
$51.25
|
| Rate for Payer: Blue Shield of California EPN |
$35.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.25
|
| Rate for Payer: Cash Price |
$36.37
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Central Health Plan Commercial |
$64.66
|
| Rate for Payer: Central Health Plan Commercial |
$70.38
|
| Rate for Payer: Cigna of CA HMO |
$61.58
|
| Rate for Payer: Cigna of CA HMO |
$56.58
|
| Rate for Payer: Cigna of CA PPO |
$56.58
|
| Rate for Payer: Cigna of CA PPO |
$61.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Senior |
$35.19
|
| Rate for Payer: EPIC Health Plan Senior |
$32.33
|
| Rate for Payer: Galaxy Health WC |
$68.71
|
| Rate for Payer: Galaxy Health WC |
$74.77
|
| Rate for Payer: Global Benefits Group Commercial |
$48.50
|
| Rate for Payer: Global Benefits Group Commercial |
$52.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.58
|
| Rate for Payer: Multiplan Commercial |
$60.62
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
| Rate for Payer: Networks By Design Commercial |
$43.98
|
| Rate for Payer: Networks By Design Commercial |
$40.41
|
| Rate for Payer: Prime Health Services Commercial |
$74.77
|
| Rate for Payer: Prime Health Services Commercial |
$68.71
|
| Rate for Payer: Riverside University Health System MISP |
$35.19
|
| Rate for Payer: Riverside University Health System MISP |
$32.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.53
|
| Rate for Payer: United Healthcare All Other HMO |
$32.14
|
| Rate for Payer: United Healthcare HMO Rider |
$28.89
|
| Rate for Payer: United Healthcare HMO Rider |
$31.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.77
|
| Rate for Payer: Vantage Medical Group Senior |
$68.71
|
| Rate for Payer: Vantage Medical Group Senior |
$74.77
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$87.97
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$79.17 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Blue Shield of California Commercial |
$70.55
|
| Rate for Payer: Blue Shield of California Commercial |
$64.83
|
| Rate for Payer: Blue Shield of California EPN |
$40.74
|
| Rate for Payer: Blue Shield of California EPN |
$44.34
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cash Price |
$36.37
|
| Rate for Payer: Central Health Plan Commercial |
$70.38
|
| Rate for Payer: Central Health Plan Commercial |
$64.66
|
| Rate for Payer: Cigna of CA HMO |
$56.58
|
| Rate for Payer: Cigna of CA HMO |
$61.58
|
| Rate for Payer: Cigna of CA PPO |
$56.58
|
| Rate for Payer: Cigna of CA PPO |
$61.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Senior |
$32.33
|
| Rate for Payer: EPIC Health Plan Senior |
$35.19
|
| Rate for Payer: Galaxy Health WC |
$74.77
|
| Rate for Payer: Galaxy Health WC |
$68.71
|
| Rate for Payer: Global Benefits Group Commercial |
$48.50
|
| Rate for Payer: Global Benefits Group Commercial |
$52.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.17
|
| Rate for Payer: Multiplan Commercial |
$60.62
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
| Rate for Payer: Networks By Design Commercial |
$40.41
|
| Rate for Payer: Networks By Design Commercial |
$43.98
|
| Rate for Payer: Prime Health Services Commercial |
$74.77
|
| Rate for Payer: Prime Health Services Commercial |
$68.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.02
|
| Rate for Payer: United Healthcare All Other HMO |
$32.14
|
| Rate for Payer: United Healthcare All Other HMO |
$29.53
|
| Rate for Payer: United Healthcare HMO Rider |
$28.89
|
| Rate for Payer: United Healthcare HMO Rider |
$31.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.81
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.25
|
| Rate for Payer: Blue Shield of California Commercial |
$102.49
|
| Rate for Payer: Blue Shield of California Commercial |
$97.85
|
| Rate for Payer: Blue Shield of California Commercial |
$93.20
|
| Rate for Payer: Blue Shield of California EPN |
$61.58
|
| Rate for Payer: Blue Shield of California EPN |
$58.65
|
| Rate for Payer: Blue Shield of California EPN |
$64.50
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$72.75
|
| Rate for Payer: Cash Price |
$69.45
|
| Rate for Payer: Central Health Plan Commercial |
$123.47
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Central Health Plan Commercial |
$129.33
|
| Rate for Payer: Cigna of CA HMO |
$113.16
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA HMO |
$108.04
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Cigna of CA PPO |
$113.16
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$61.74
|
| Rate for Payer: EPIC Health Plan Senior |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Galaxy Health WC |
$131.19
|
| Rate for Payer: Galaxy Health WC |
$137.41
|
| Rate for Payer: Global Benefits Group Commercial |
$92.60
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Global Benefits Group Commercial |
$97.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$108.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
| Rate for Payer: Networks By Design Commercial |
$77.17
|
| Rate for Payer: Networks By Design Commercial |
$80.83
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$131.19
|
| Rate for Payer: Prime Health Services Commercial |
$137.41
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Riverside University Health System MISP |
$58.80
|
| Rate for Payer: Riverside University Health System MISP |
$61.74
|
| Rate for Payer: Riverside University Health System MISP |
$64.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$59.05
|
| Rate for Payer: United Healthcare All Other HMO |
$56.38
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$57.78
|
| Rate for Payer: United Healthcare HMO Rider |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.41
|
| Rate for Payer: Vantage Medical Group Senior |
$131.19
|
| Rate for Payer: Vantage Medical Group Senior |
$137.41
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$161.66
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$145.49 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$129.65
|
| Rate for Payer: Blue Shield of California Commercial |
$123.78
|
| Rate for Payer: Blue Shield of California Commercial |
$117.89
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Blue Shield of California EPN |
$81.48
|
| Rate for Payer: Blue Shield of California EPN |
$77.79
|
| Rate for Payer: Cash Price |
$72.75
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$69.45
|
| Rate for Payer: Central Health Plan Commercial |
$123.47
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Central Health Plan Commercial |
$129.33
|
| Rate for Payer: Cigna of CA HMO |
$113.16
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA HMO |
$108.04
|
| Rate for Payer: Cigna of CA PPO |
$113.16
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Senior |
$61.74
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$131.19
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Galaxy Health WC |
$137.41
|
| Rate for Payer: Global Benefits Group Commercial |
$97.00
|
| Rate for Payer: Global Benefits Group Commercial |
$92.60
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$80.83
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$77.17
|
| Rate for Payer: Prime Health Services Commercial |
$131.19
|
| Rate for Payer: Prime Health Services Commercial |
$137.41
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.92
|
| Rate for Payer: United Healthcare All Other HMO |
$56.38
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare All Other HMO |
$59.05
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare HMO Rider |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$57.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
REMOVAL AND REPLACEMENT OF EXTERNALLY ACCESSIBLE NEPHROURETERAL CATHETER (EG, EXTERNAL/INTERNAL STENT) REQUIRING FLUOROSCOPIC GUIDANCE, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 50387
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$776.75 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,688.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| 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 |
$4,147.14
|
| 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 |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$776.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$858.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| 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 |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| 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 |
$120.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Preferred Health Network WC |
$122.70
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
REMOVAL OF BONE FLAP OR PROSTHETIC PLATE OF SKULL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 62142
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,062.36 |
| 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 |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| 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 |
$1,062.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,173.54
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
|
|
REMOVAL OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY AND PULSE GENERATOR
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 64570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$756.90 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,393.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,590.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,833.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,393.74
|
| 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 |
$12,964.88
|
| 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 |
$6,590.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,833.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,393.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,249.67
|
| Rate for Payer: EPIC Health Plan Senior |
$4,833.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,205.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$756.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$836.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,151.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,887.61
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,393.74
|
| Rate for Payer: Preferred Health Network WC |
$13,229.47
|
| Rate for Payer: Prime Health Services Medicare |
$4,657.36
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Riverside University Health System MISP |
$4,833.11
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,393.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,590.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,833.11
|
| Rate for Payer: Vantage Medical Group Senior |
$4,393.74
|
|
|
REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 45915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$354.11 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,387.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$391.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Preferred Health Network WC |
$2,435.74
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 57415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$272.95 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,163.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| 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 |
$6,436.87
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$272.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 20680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$261.27 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,735.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| 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 |
$5,794.14
|
| 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 |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$261.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Preferred Health Network WC |
$5,912.39
|
| Rate for Payer: Prime Health Services Medicare |
$3,960.11
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Riverside University Health System MISP |
$4,109.55
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
REMOVAL OF IMPLANTED MATERIAL, ANTERIOR SEGMENT OF EYE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 65920
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.90 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,968.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$886.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$979.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,155.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 20670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| 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 |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$199.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| 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 |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
REMOVAL OF INTACT BREAST IMPLANT
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 19328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$555.18 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,035.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| 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 |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$555.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$613.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,050.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| 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 |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
