|
SPIRONOLACTONE 50 MG TABLET [11426]
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 6068747601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
| Rate for Payer: Riverside University Health System MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
SPIRONOLACTONE 50 MG TABLET [11426]
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
NDC 6068747611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
|
|
SPIRONOLACTONE 50 MG TABLET [11426]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 6958485310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
|
|
SPIRONOLACTONE/HCTZ ORAL SUSP COMPOUND 5 MG/ML [4080340]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 9994080340
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
SPIRONOLACTONE/HCTZ ORAL SUSP COMPOUND 5 MG/ML [4080340]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 9994080340
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
SPIRONOLACTONE ORAL SUSPENSION COMPOUND 2.5 MG/ML [4080339]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
NDC 9994080339
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
|
|
SPIRONOLACTONE ORAL SUSPENSION COMPOUND 2.5 MG/ML [4080339]
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
NDC 9994080339
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
| Rate for Payer: Riverside University Health System MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$32,110.21
|
|
|
Service Code
|
APR-DRG 6502
|
| Min. Negotiated Rate |
$20,280.13 |
| Max. Negotiated Rate |
$32,110.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,280.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24,167.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32,110.21
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$42,118.72
|
|
|
Service Code
|
APR-DRG 6503
|
| Min. Negotiated Rate |
$26,601.30 |
| Max. Negotiated Rate |
$42,118.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,601.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31,699.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,118.72
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$23,308.21
|
|
|
Service Code
|
APR-DRG 6501
|
| Min. Negotiated Rate |
$14,720.98 |
| Max. Negotiated Rate |
$23,308.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,720.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,542.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,308.21
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$66,593.16
|
|
|
Service Code
|
APR-DRG 6504
|
| Min. Negotiated Rate |
$42,058.84 |
| Max. Negotiated Rate |
$66,593.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$42,058.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50,120.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66,593.16
|
|
|
SPLENIC PROCEDURES WITH CC
|
Facility
|
IP
|
$73,940.60
|
|
|
Service Code
|
MSDRG 800
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$73,940.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73,940.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47,762.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66,869.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$65,420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$43,613.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39,648.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55,508.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53,129.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$39,648.97
|
| Rate for Payer: Prime Health Services Medicare |
$42,027.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
SPLENIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$119,196.12
|
|
|
Service Code
|
MSDRG 799
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$119,196.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119,196.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$76,995.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107,796.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$104,551.26
|
| Rate for Payer: EPIC Health Plan Senior |
$69,700.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,364.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,710.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84,908.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$63,364.40
|
| Rate for Payer: Prime Health Services Medicare |
$67,166.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
SPLENIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$50,240.34
|
|
|
Service Code
|
MSDRG 801
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$50,240.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50,240.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32,453.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,435.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,928.21
|
| Rate for Payer: EPIC Health Plan Senior |
$29,952.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,229.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,120.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36,487.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27,229.22
|
| Rate for Payer: Prime Health Services Medicare |
$28,862.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
SPLIT-THICKNESS AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$797.89 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,557.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,557.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$7,411.53
|
| 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 |
$6,836.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,013.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,557.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,013.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,474.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$797.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$881.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,380.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,107.48
|
| Rate for Payer: Multiplan WC |
$7,411.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Preferred Health Network WC |
$7,562.79
|
| Rate for Payer: Prime Health Services Medicare |
$4,831.29
|
| Rate for Payer: Prime Health Services WC |
$7,335.91
|
| Rate for Payer: Riverside University Health System MISP |
$5,013.60
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,557.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,557.82
|
|
|
SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.57 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$456.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$504.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC
|
Facility
|
IP
|
$25,116.22
|
|
|
Service Code
|
MSDRG 537
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$25,116.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,116.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,224.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,714.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,204.54
|
| Rate for Payer: EPIC Health Plan Senior |
$15,469.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,063.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,688.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,844.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,063.36
|
| Rate for Payer: Prime Health Services Medicare |
$14,907.16
|
| 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
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC
|
Facility
|
IP
|
$18,957.58
|
|
|
Service Code
|
MSDRG 538
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$18,957.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,957.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,245.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,144.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,879.43
|
| Rate for Payer: EPIC Health Plan Senior |
$11,919.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,836.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,170.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,520.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,836.02
|
| Rate for Payer: Prime Health Services Medicare |
$11,486.18
|
| 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
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; 10-20 STAB INCISIONS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 37765
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$396.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| 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 |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$396.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$437.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 37766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$496.27 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| 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 |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$496.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$548.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH OR WITHOUT USE OF FOREIGN MATERIAL;
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,280.71 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,280.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; CRANIAL, EXTRADURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 61782
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.71 |
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.54
|
| 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
|
|
|
STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; SPINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 61783
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.26 |
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$334.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$369.25
|
| 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
|
|
|
STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]
|
Facility
|
IP
|
$234.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Adventist Health Commercial |
$46.92
|
| Rate for Payer: Blue Shield of California Commercial |
$188.15
|
| Rate for Payer: Blue Shield of California EPN |
$118.24
|
| Rate for Payer: Cash Price |
$105.57
|
| Rate for Payer: Central Health Plan Commercial |
$187.68
|
| Rate for Payer: Cigna of CA HMO |
$164.22
|
| Rate for Payer: Cigna of CA PPO |
$164.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.84
|
| Rate for Payer: EPIC Health Plan Senior |
$93.84
|
| Rate for Payer: Galaxy Health WC |
$199.41
|
| Rate for Payer: Global Benefits Group Commercial |
$140.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$148.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.92
|
| Rate for Payer: Multiplan Commercial |
$175.95
|
| Rate for Payer: Networks By Design Commercial |
$117.30
|
| Rate for Payer: Prime Health Services Commercial |
$199.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.05
|
| Rate for Payer: United Healthcare All Other HMO |
$85.70
|
| Rate for Payer: United Healthcare HMO Rider |
$83.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.83
|
|
|
STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Adventist Health Commercial |
$46.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.95
|
| Rate for Payer: Blue Shield of California Commercial |
$148.74
|
| Rate for Payer: Blue Shield of California EPN |
$93.61
|
| Rate for Payer: Cash Price |
$105.57
|
| Rate for Payer: Central Health Plan Commercial |
$187.68
|
| Rate for Payer: Cigna of CA HMO |
$164.22
|
| Rate for Payer: Cigna of CA PPO |
$164.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.84
|
| Rate for Payer: EPIC Health Plan Senior |
$93.84
|
| Rate for Payer: Galaxy Health WC |
$199.41
|
| Rate for Payer: Global Benefits Group Commercial |
$140.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$148.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$164.22
|
| Rate for Payer: Multiplan Commercial |
$175.95
|
| Rate for Payer: Networks By Design Commercial |
$117.30
|
| Rate for Payer: Prime Health Services Commercial |
$199.41
|
| Rate for Payer: Riverside University Health System MISP |
$93.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.05
|
| Rate for Payer: United Healthcare All Other HMO |
$85.70
|
| Rate for Payer: United Healthcare HMO Rider |
$83.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.41
|
| Rate for Payer: Vantage Medical Group Senior |
$199.41
|
|
