|
Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of urethra
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 54300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 54304
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Plastic operation on penis to correct angulation
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 54360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Plastic operation on urethral sphincter, vaginal approach (eg, Kelly urethral plication)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 57220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,214.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$6,214.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,389.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,214.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,191.89
|
| Rate for Payer: IEHP medi-cal |
$10,254.04
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Innovage PACE Commercial |
$9,321.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,214.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,327.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,327.52
|
| Rate for Payer: Prime Health Services Medicare |
$6,587.44
|
| Rate for Payer: Riverside University Health MISP |
$6,836.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
|
Plastic repair of canaliculi
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 68700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,919.67 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Plastic repair of introitus
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 56800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: IEHP medi-cal |
$6,445.20
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Innovage PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health MISP |
$4,296.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
Plastic repair of salivary duct, sialodochoplasty; primary or simple
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 42500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Plastic repair of salivary duct, sialodochoplasty; secondary or complicated
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 42505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]
|
Facility
OP
|
$541.63
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
1721197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$1,582.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,582.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$460.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$297.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$297.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.43
|
| Rate for Payer: BCBS Transplant Transplant |
$324.98
|
| Rate for Payer: Blue Shield of California Commercial |
$265.65
|
| Rate for Payer: Blue Shield of California EPN |
$241.50
|
| Rate for Payer: Cash Price |
$243.73
|
| Rate for Payer: Cash Price |
$243.73
|
| Rate for Payer: Central Health Plan Commercial |
$433.30
|
| Rate for Payer: Cigna of CA HMO |
$379.14
|
| Rate for Payer: Cigna of CA PPO |
$379.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.65
|
| Rate for Payer: Galaxy Health WC |
$460.39
|
| Rate for Payer: Global Benefits Group Commercial |
$324.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$487.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$406.22
|
| Rate for Payer: IEHP medi-cal |
$257.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.33
|
| Rate for Payer: Multiplan Commercial |
$406.22
|
| Rate for Payer: Networks By Design Commercial |
$270.82
|
| Rate for Payer: Prime Health Services Commercial |
$460.39
|
| Rate for Payer: Riverside University Health MISP |
$216.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.82
|
| Rate for Payer: United Healthcare All Other HMO |
$270.82
|
| Rate for Payer: United Healthcare HMO Rider |
$270.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$460.39
|
| Rate for Payer: Vantage Medical Group Senior |
$460.39
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]
|
Facility
IP
|
$541.63
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
1721197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$487.47 |
| Rate for Payer: Blue Shield of California Commercial |
$406.22
|
| Rate for Payer: Blue Shield of California EPN |
$289.23
|
| Rate for Payer: Cash Price |
$243.73
|
| Rate for Payer: Central Health Plan Commercial |
$433.30
|
| Rate for Payer: Cigna of CA HMO |
$379.14
|
| Rate for Payer: Cigna of CA PPO |
$379.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.65
|
| Rate for Payer: Galaxy Health WC |
$460.39
|
| Rate for Payer: Global Benefits Group Commercial |
$324.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$487.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.33
|
| Rate for Payer: Multiplan Commercial |
$406.22
|
| Rate for Payer: Networks By Design Commercial |
$270.82
|
| Rate for Payer: Prime Health Services Commercial |
$460.39
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
OP
|
$626.81
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
NDG231988A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.36 |
| Max. Negotiated Rate |
$1,771.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,771.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,771.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$532.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$516.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$334.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$344.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$344.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$334.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$470.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$470.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.72
|
| Rate for Payer: BCBS Transplant Transplant |
$364.63
|
| Rate for Payer: BCBS Transplant Transplant |
$376.09
|
| Rate for Payer: Blue Shield of California Commercial |
$382.25
|
| Rate for Payer: Blue Shield of California Commercial |
$394.26
|
| Rate for Payer: Blue Shield of California EPN |
$306.51
|
| Rate for Payer: Blue Shield of California EPN |
$297.17
|
| Rate for Payer: Cash Price |
$273.47
|
| Rate for Payer: Cash Price |
$282.06
|
| Rate for Payer: Cash Price |
$273.47
|
| Rate for Payer: Cash Price |
$282.06
|
| Rate for Payer: Central Health Plan Commercial |
$486.17
|
| Rate for Payer: Central Health Plan Commercial |
$501.45
|
| Rate for Payer: Cigna of CA HMO |
$425.40
|
| Rate for Payer: Cigna of CA HMO |
$438.77
|
| Rate for Payer: Cigna of CA PPO |
$438.77
|
| Rate for Payer: Cigna of CA PPO |
$425.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$532.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$516.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$243.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.72
|
| Rate for Payer: Galaxy Health WC |
$516.55
|
| Rate for Payer: Galaxy Health WC |
$532.79
|
| Rate for Payer: Global Benefits Group Commercial |
$376.09
|
| Rate for Payer: Global Benefits Group Commercial |
$364.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$564.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$546.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$455.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$470.11
|
| Rate for Payer: IEHP medi-cal |
$298.04
|
| Rate for Payer: IEHP medi-cal |
$298.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$418.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$405.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.36
|
| Rate for Payer: Multiplan Commercial |
$455.78
|
| Rate for Payer: Multiplan Commercial |
$470.11
|
| Rate for Payer: Networks By Design Commercial |
$303.86
|
| Rate for Payer: Networks By Design Commercial |
$313.40
|
| Rate for Payer: Prime Health Services Commercial |
$532.79
|
| Rate for Payer: Prime Health Services Commercial |
$516.55
|
| Rate for Payer: Riverside University Health MISP |
$250.72
|
| Rate for Payer: Riverside University Health MISP |
$243.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$364.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$376.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$376.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$364.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$313.40
|
| Rate for Payer: United Healthcare All Other HMO |
$313.40
|
| Rate for Payer: United Healthcare All Other HMO |
$303.86
|
| Rate for Payer: United Healthcare HMO Rider |
$303.86
|
| Rate for Payer: United Healthcare HMO Rider |
$313.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$532.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$516.55
|
| Rate for Payer: Vantage Medical Group Senior |
$516.55
|
| Rate for Payer: Vantage Medical Group Senior |
$532.79
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
IP
|
$607.71
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
NDG231988A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.54 |
| Max. Negotiated Rate |
$546.94 |
| Rate for Payer: Blue Shield of California Commercial |
$455.78
|
| Rate for Payer: Blue Shield of California Commercial |
$470.11
|
| Rate for Payer: Blue Shield of California EPN |
$324.52
|
| Rate for Payer: Blue Shield of California EPN |
$334.72
|
| Rate for Payer: Cash Price |
$282.06
|
| Rate for Payer: Cash Price |
$273.47
|
| Rate for Payer: Central Health Plan Commercial |
$501.45
|
| Rate for Payer: Central Health Plan Commercial |
$486.17
|
| Rate for Payer: Cigna of CA HMO |
$438.77
|
| Rate for Payer: Cigna of CA HMO |
$425.40
|
| Rate for Payer: Cigna of CA PPO |
$438.77
|
| Rate for Payer: Cigna of CA PPO |
$425.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$243.08
|
| Rate for Payer: Galaxy Health WC |
$532.79
|
| Rate for Payer: Galaxy Health WC |
$516.55
|
| Rate for Payer: Global Benefits Group Commercial |
$376.09
|
| Rate for Payer: Global Benefits Group Commercial |
$364.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$564.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$546.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$418.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$405.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.36
|
| Rate for Payer: Multiplan Commercial |
$455.78
|
| Rate for Payer: Multiplan Commercial |
$470.11
|
| Rate for Payer: Networks By Design Commercial |
$303.86
|
| Rate for Payer: Networks By Design Commercial |
$313.40
|
| Rate for Payer: Prime Health Services Commercial |
$532.79
|
| Rate for Payer: Prime Health Services Commercial |
$516.55
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION [11037]
|
Facility
OP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
NDG11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$818.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.68
|
| Rate for Payer: BCBS Transplant Transplant |
$168.59
|
| Rate for Payer: Blue Shield of California Commercial |
$145.81
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.74
|
| Rate for Payer: IEHP medi-cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Riverside University Health MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.50
|
| Rate for Payer: United Healthcare All Other HMO |
$140.50
|
| Rate for Payer: United Healthcare HMO Rider |
$140.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION [11037]
|
Facility
IP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
NDG11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$252.89 |
| Rate for Payer: Blue Shield of California Commercial |
$210.74
|
| Rate for Payer: Blue Shield of California EPN |
$150.05
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [113995]
|
Facility
IP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
1720337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$252.89 |
| Rate for Payer: Blue Shield of California Commercial |
$210.74
|
| Rate for Payer: Blue Shield of California EPN |
$150.05
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [113995]
|
Facility
OP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
1720337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$818.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.68
|
| Rate for Payer: BCBS Transplant Transplant |
$168.59
|
| Rate for Payer: Blue Shield of California Commercial |
$145.81
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.74
|
| Rate for Payer: IEHP medi-cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Riverside University Health MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.50
|
| Rate for Payer: United Healthcare All Other HMO |
$140.50
|
| Rate for Payer: United Healthcare HMO Rider |
$140.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
IP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
NDG11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$252.89 |
| Rate for Payer: Blue Shield of California Commercial |
$210.74
|
| Rate for Payer: Blue Shield of California EPN |
$150.05
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
OP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
NDG11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$818.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.68
|
| Rate for Payer: BCBS Transplant Transplant |
$168.59
|
| Rate for Payer: Blue Shield of California Commercial |
$145.81
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.74
|
| Rate for Payer: IEHP medi-cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Riverside University Health MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.50
|
| Rate for Payer: United Healthcare All Other HMO |
$140.50
|
| Rate for Payer: United Healthcare HMO Rider |
$140.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
IP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
1720337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$252.89 |
| Rate for Payer: Blue Shield of California Commercial |
$210.74
|
| Rate for Payer: Blue Shield of California EPN |
$150.05
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
OP
|
$280.99
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
1720337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$818.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.68
|
| Rate for Payer: BCBS Transplant Transplant |
$168.59
|
| Rate for Payer: Blue Shield of California Commercial |
$145.81
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.79
|
| Rate for Payer: Cigna of CA HMO |
$196.69
|
| Rate for Payer: Cigna of CA PPO |
$196.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.84
|
| Rate for Payer: Global Benefits Group Commercial |
$168.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.74
|
| Rate for Payer: IEHP medi-cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.84
|
| Rate for Payer: Riverside University Health MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.50
|
| Rate for Payer: United Healthcare All Other HMO |
$140.50
|
| Rate for Payer: United Healthcare HMO Rider |
$140.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
IP
|
$15,560.66
|
|
|
Service Code
|
APR-DRG 8124
|
| Min. Negotiated Rate |
$13,057.90 |
| Max. Negotiated Rate |
$15,560.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,057.90
|
| Rate for Payer: IEHP medi-cal |
$15,560.66
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
IP
|
$4,184.48
|
|
|
Service Code
|
APR-DRG 8121
|
| Min. Negotiated Rate |
$3,511.45 |
| Max. Negotiated Rate |
$4,184.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,511.45
|
| Rate for Payer: IEHP medi-cal |
$4,184.48
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
IP
|
$8,746.70
|
|
|
Service Code
|
APR-DRG 8123
|
| Min. Negotiated Rate |
$7,339.88 |
| Max. Negotiated Rate |
$8,746.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,339.88
|
| Rate for Payer: IEHP medi-cal |
$8,746.70
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
IP
|
$5,970.39
|
|
|
Service Code
|
APR-DRG 8122
|
| Min. Negotiated Rate |
$5,010.12 |
| Max. Negotiated Rate |
$5,970.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,010.12
|
| Rate for Payer: IEHP medi-cal |
$5,970.39
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION [225066]
|
Facility
IP
|
$19,860.05
|
|
|
Service Code
|
NDC 50242-105-01
|
| Hospital Charge Code |
ERX225066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,972.01 |
| Max. Negotiated Rate |
$17,874.04 |
| Rate for Payer: Blue Shield of California Commercial |
$14,895.04
|
| Rate for Payer: Blue Shield of California EPN |
$10,605.27
|
| Rate for Payer: Cash Price |
$8,937.02
|
| Rate for Payer: Central Health Plan Commercial |
$15,888.04
|
| Rate for Payer: Cigna of CA HMO |
$13,902.04
|
| Rate for Payer: Cigna of CA PPO |
$13,902.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,944.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,944.02
|
| Rate for Payer: Galaxy Health WC |
$16,881.04
|
| Rate for Payer: Global Benefits Group Commercial |
$11,916.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,874.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,246.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,972.01
|
| Rate for Payer: Multiplan Commercial |
$14,895.04
|
| Rate for Payer: Networks By Design Commercial |
$9,930.02
|
| Rate for Payer: Prime Health Services Commercial |
$16,881.04
|
|
