|
STERILE TALC 5 GRAM INTRAPLEURAL SUSPENSION [37812]
|
Facility
|
IP
|
$119.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$107.46 |
| Rate for Payer: Adventist Health Commercial |
$23.88
|
| Rate for Payer: Blue Shield of California Commercial |
$95.76
|
| Rate for Payer: Blue Shield of California EPN |
$60.18
|
| Rate for Payer: Cash Price |
$53.73
|
| Rate for Payer: Central Health Plan Commercial |
$95.52
|
| Rate for Payer: Cigna of CA HMO |
$83.58
|
| Rate for Payer: Cigna of CA PPO |
$83.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.76
|
| Rate for Payer: EPIC Health Plan Senior |
$47.76
|
| Rate for Payer: Galaxy Health WC |
$101.49
|
| Rate for Payer: Global Benefits Group Commercial |
$71.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.88
|
| Rate for Payer: Multiplan Commercial |
$89.55
|
| Rate for Payer: Networks By Design Commercial |
$59.70
|
| Rate for Payer: Prime Health Services Commercial |
$101.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.81
|
| Rate for Payer: United Healthcare All Other HMO |
$43.62
|
| Rate for Payer: United Healthcare HMO Rider |
$42.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.10
|
|
|
STERILE TALC 5 GRAM INTRAPLEURAL SUSPENSION [37812]
|
Facility
|
OP
|
$119.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$107.46 |
| Rate for Payer: Adventist Health Commercial |
$23.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.55
|
| Rate for Payer: Blue Shield of California Commercial |
$75.70
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$53.73
|
| Rate for Payer: Central Health Plan Commercial |
$95.52
|
| Rate for Payer: Cigna of CA HMO |
$83.58
|
| Rate for Payer: Cigna of CA PPO |
$83.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$101.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.76
|
| Rate for Payer: EPIC Health Plan Senior |
$47.76
|
| Rate for Payer: Galaxy Health WC |
$101.49
|
| Rate for Payer: Global Benefits Group Commercial |
$71.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.58
|
| Rate for Payer: Multiplan Commercial |
$89.55
|
| Rate for Payer: Networks By Design Commercial |
$59.70
|
| Rate for Payer: Prime Health Services Commercial |
$101.49
|
| Rate for Payer: Riverside University Health System MISP |
$47.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.81
|
| Rate for Payer: United Healthcare All Other HMO |
$43.62
|
| Rate for Payer: United Healthcare HMO Rider |
$42.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.49
|
| Rate for Payer: Vantage Medical Group Senior |
$101.49
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
HCPCS A4216
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.16
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.33
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
HCPCS A4216
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Riverside University Health System MISP |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC
|
Facility
|
IP
|
$64,328.90
|
|
|
Service Code
|
MSDRG 327
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$64,328.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64,328.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41,553.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58,176.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,110.00
|
| Rate for Payer: EPIC Health Plan Senior |
$38,073.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,612.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48,456.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46,380.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$34,612.12
|
| Rate for Payer: Prime Health Services Medicare |
$36,688.85
|
| 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
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$131,263.38
|
|
|
Service Code
|
MSDRG 326
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$131,263.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$131,263.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84,790.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118,710.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$114,985.30
|
| Rate for Payer: EPIC Health Plan Senior |
$76,656.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$69,688.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97,563.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$93,382.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$69,688.06
|
| Rate for Payer: Prime Health Services Medicare |
$73,869.34
|
| 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
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$42,170.93
|
|
|
Service Code
|
MSDRG 328
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$42,170.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,170.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,240.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38,137.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,950.99
|
| Rate for Payer: EPIC Health Plan Senior |
$25,300.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,000.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,200.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,820.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,000.60
|
| Rate for Payer: Prime Health Services Medicare |
$24,380.64
|
| 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
|
|
|
STRABISMUS SURGERY ON PATIENT WITH PREVIOUS EYE SURGERY OR INJURY THAT DID NOT INVOLVE THE EXTRAOCULAR MUSCLES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,000.00 |
| 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 |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| 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
|
|
|
STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; 1 HORIZONTAL MUSCLE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67311
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.29 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| 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 |
$4,723.01
|
| 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 |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| 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 |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; 1 VERTICAL MUSCLE (EXCLUDING SUPERIOR OBLIQUE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67314
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,057.84 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| 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 |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; 2 HORIZONTAL MUSCLES
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67312
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$896.50 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,056.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,584.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,562.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,056.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,634.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,584.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,562.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,056.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,343.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5,562.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,292.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$896.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,056.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$990.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,079.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,775.62
|
| Rate for Payer: Multiplan WC |
$7,634.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,056.43
|
| Rate for Payer: Preferred Health Network WC |
$7,790.10
|
| Rate for Payer: Prime Health Services Medicare |
$5,359.82
|
| Rate for Payer: Prime Health Services WC |
$7,556.40
|
| Rate for Payer: Riverside University Health System MISP |
$5,562.07
|
| 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 |
$5,056.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,584.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,562.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5,056.43
|
|
|
STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION [7508]
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$158.55 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.29
|
| Rate for Payer: Blue Shield of California Commercial |
$103.12
|
| Rate for Payer: Blue Shield of California EPN |
$93.75
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Riverside University Health System MISP |
$36.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION [7508]
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$72.18
|
| Rate for Payer: Blue Shield of California EPN |
$45.36
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
|
|
STYLET SLICK INTUBATION 6FR
|
Facility
|
IP
|
$21.65
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Adventist Health Commercial |
$4.33
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Central Health Plan Commercial |
$17.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.66
|
| Rate for Payer: EPIC Health Plan Senior |
$8.66
|
| Rate for Payer: Galaxy Health WC |
$18.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$16.24
|
| Rate for Payer: Networks By Design Commercial |
$14.07
|
| Rate for Payer: Prime Health Services Commercial |
$18.40
|
|
|
STYLET SLICK INTUBATION 6FR
|
Facility
|
OP
|
$21.65
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Adventist Health Commercial |
$4.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.59
|
| Rate for Payer: Blue Shield of California Commercial |
$13.73
|
| Rate for Payer: Blue Shield of California EPN |
$8.64
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Central Health Plan Commercial |
$17.32
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$16.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.66
|
| Rate for Payer: EPIC Health Plan Senior |
$8.66
|
| Rate for Payer: Galaxy Health WC |
$18.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.15
|
| Rate for Payer: Multiplan Commercial |
$16.24
|
| Rate for Payer: Networks By Design Commercial |
$14.07
|
| Rate for Payer: Prime Health Services Commercial |
$18.40
|
| Rate for Payer: Riverside University Health System MISP |
$8.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.82
|
| Rate for Payer: United Healthcare All Other HMO |
$10.82
|
| Rate for Payer: United Healthcare HMO Rider |
$10.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.40
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
SUBCONJUNCTIVAL INJECTION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 68200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.18 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$574.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| 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 |
$807.84
|
| 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 |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$190.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$804.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$574.56
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Medicare |
$609.03
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$632.02
|
| 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 |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
SUBMUCOUS RESECTION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 30140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$410.46 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,264.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| 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 |
$6,565.51
|
| 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 |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$410.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$453.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,969.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| 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 |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
SUCCIMER 100 MG CAPSULE [11438]
|
Facility
|
IP
|
$26.44
|
|
|
Service Code
|
NDC 5529220111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.29
|
| Rate for Payer: Blue Shield of California Commercial |
$21.20
|
| Rate for Payer: Blue Shield of California EPN |
$13.33
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Central Health Plan Commercial |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$18.51
|
| Rate for Payer: Cigna of CA PPO |
$18.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.58
|
| Rate for Payer: EPIC Health Plan Senior |
$10.58
|
| Rate for Payer: Galaxy Health WC |
$22.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$19.83
|
| Rate for Payer: Networks By Design Commercial |
$17.19
|
| Rate for Payer: Prime Health Services Commercial |
$22.47
|
|
|
SUCCIMER 100 MG CAPSULE [11438]
|
Facility
|
OP
|
$26.44
|
|
|
Service Code
|
NDC 5529220111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.38
|
| Rate for Payer: Blue Shield of California Commercial |
$16.76
|
| Rate for Payer: Blue Shield of California EPN |
$10.55
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Central Health Plan Commercial |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$18.51
|
| Rate for Payer: Cigna of CA PPO |
$18.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.58
|
| Rate for Payer: EPIC Health Plan Senior |
$10.58
|
| Rate for Payer: Galaxy Health WC |
$22.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.51
|
| Rate for Payer: Multiplan Commercial |
$19.83
|
| Rate for Payer: Networks By Design Commercial |
$17.19
|
| Rate for Payer: Prime Health Services Commercial |
$22.47
|
| Rate for Payer: Riverside University Health System MISP |
$10.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.22
|
| Rate for Payer: United Healthcare All Other HMO |
$13.22
|
| Rate for Payer: United Healthcare HMO Rider |
$13.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.47
|
| Rate for Payer: Vantage Medical Group Senior |
$22.47
|
|
|
SUCCINYLCHOLINE CHLORIDE 100 MG/5 ML (20 MG/ML) INTRAVENOUS SYRINGE [121307]
|
Facility
|
OP
|
$3.63
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$10.73 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$2.90
|
| Rate for Payer: Central Health Plan Commercial |
$4.12
|
| Rate for Payer: Cigna of CA HMO |
$2.54
|
| Rate for Payer: Cigna of CA HMO |
$3.60
|
| Rate for Payer: Cigna of CA PPO |
$3.60
|
| Rate for Payer: Cigna of CA PPO |
$2.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: EPIC Health Plan Senior |
$1.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$4.38
|
| Rate for Payer: Galaxy Health WC |
$3.09
|
| Rate for Payer: Global Benefits Group Commercial |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$3.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$2.72
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.38
|
| Rate for Payer: Riverside University Health System MISP |
$2.06
|
| Rate for Payer: Riverside University Health System MISP |
$1.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.38
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3.09
|
|
|
SUCCINYLCHOLINE CHLORIDE 100 MG/5 ML (20 MG/ML) INTRAVENOUS SYRINGE [121307]
|
Facility
|
IP
|
$5.15
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$4.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$4.12
|
| Rate for Payer: Central Health Plan Commercial |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$2.54
|
| Rate for Payer: Cigna of CA HMO |
$3.60
|
| Rate for Payer: Cigna of CA PPO |
$2.54
|
| Rate for Payer: Cigna of CA PPO |
$3.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: EPIC Health Plan Senior |
$1.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$4.38
|
| Rate for Payer: Galaxy Health WC |
$3.09
|
| Rate for Payer: Global Benefits Group Commercial |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$3.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$4.38
|
| Rate for Payer: Prime Health Services Commercial |
$3.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
|
|
SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML INJECTION VIAL - CODE [4087536]
|
Facility
|
IP
|
$1.01
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.86
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
|
|
SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML INJECTION VIAL - CODE [4087536]
|
Facility
|
OP
|
$1.01
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$10.73 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.86
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.86
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Vantage Medical Group Senior |
$0.86
|
|
