|
SUNITINIB MALATE 12.5 MG CAPSULE [70424]
|
Facility
|
IP
|
$276.70
|
|
|
Service Code
|
NDC 0069055038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$249.03 |
| Rate for Payer: Adventist Health Commercial |
$55.34
|
| Rate for Payer: Blue Shield of California Commercial |
$221.91
|
| Rate for Payer: Blue Shield of California EPN |
$139.46
|
| Rate for Payer: Cash Price |
$124.52
|
| Rate for Payer: Central Health Plan Commercial |
$221.36
|
| Rate for Payer: Cigna of CA HMO |
$193.69
|
| Rate for Payer: Cigna of CA PPO |
$193.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$193.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.68
|
| Rate for Payer: EPIC Health Plan Senior |
$110.68
|
| Rate for Payer: Galaxy Health WC |
$235.19
|
| Rate for Payer: Global Benefits Group Commercial |
$166.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$249.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$175.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.34
|
| Rate for Payer: Multiplan Commercial |
$207.53
|
| Rate for Payer: Networks By Design Commercial |
$179.85
|
| Rate for Payer: Prime Health Services Commercial |
$235.19
|
|
|
SUNITINIB MALATE 12.5 MG CAPSULE [70424]
|
Facility
|
OP
|
$276.70
|
|
|
Service Code
|
NDC 0069055038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$249.03 |
| Rate for Payer: Adventist Health Commercial |
$55.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.96
|
| Rate for Payer: Blue Shield of California Commercial |
$175.43
|
| Rate for Payer: Blue Shield of California EPN |
$110.40
|
| Rate for Payer: Cash Price |
$124.52
|
| Rate for Payer: Central Health Plan Commercial |
$221.36
|
| Rate for Payer: Cigna of CA HMO |
$193.69
|
| Rate for Payer: Cigna of CA PPO |
$193.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$235.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$235.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$193.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.68
|
| Rate for Payer: EPIC Health Plan Senior |
$110.68
|
| Rate for Payer: Galaxy Health WC |
$235.19
|
| Rate for Payer: Global Benefits Group Commercial |
$166.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$249.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$175.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$193.69
|
| Rate for Payer: Multiplan Commercial |
$207.53
|
| Rate for Payer: Networks By Design Commercial |
$179.85
|
| Rate for Payer: Prime Health Services Commercial |
$235.19
|
| Rate for Payer: Riverside University Health System MISP |
$110.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.35
|
| Rate for Payer: United Healthcare All Other HMO |
$138.35
|
| Rate for Payer: United Healthcare HMO Rider |
$138.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$235.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.19
|
| Rate for Payer: Vantage Medical Group Senior |
$235.19
|
|
|
SUNITINIB MALATE 25 MG CAPSULE [70425]
|
Facility
|
IP
|
$553.41
|
|
|
Service Code
|
NDC 0069077038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$110.68 |
| Max. Negotiated Rate |
$498.07 |
| Rate for Payer: Adventist Health Commercial |
$110.68
|
| Rate for Payer: Blue Shield of California Commercial |
$443.83
|
| Rate for Payer: Blue Shield of California EPN |
$278.92
|
| Rate for Payer: Cash Price |
$249.03
|
| Rate for Payer: Central Health Plan Commercial |
$442.73
|
| Rate for Payer: Cigna of CA HMO |
$387.39
|
| Rate for Payer: Cigna of CA PPO |
$387.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.36
|
| Rate for Payer: EPIC Health Plan Senior |
$221.36
|
| Rate for Payer: Galaxy Health WC |
$470.40
|
| Rate for Payer: Global Benefits Group Commercial |
$332.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$498.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.68
|
| Rate for Payer: Multiplan Commercial |
$415.06
|
| Rate for Payer: Networks By Design Commercial |
$359.72
|
| Rate for Payer: Prime Health Services Commercial |
$470.40
|
|
|
SUNITINIB MALATE 25 MG CAPSULE [70425]
|
Facility
|
OP
|
$553.41
|
|
|
Service Code
|
NDC 0069077038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$110.68 |
| Max. Negotiated Rate |
$498.07 |
| Rate for Payer: Adventist Health Commercial |
$110.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$336.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$415.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$267.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.92
|
| Rate for Payer: Blue Shield of California Commercial |
$350.86
|
| Rate for Payer: Blue Shield of California EPN |
$220.81
|
| Rate for Payer: Cash Price |
$249.03
|
| Rate for Payer: Central Health Plan Commercial |
$442.73
|
| Rate for Payer: Cigna of CA HMO |
$387.39
|
| Rate for Payer: Cigna of CA PPO |
$387.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.36
|
| Rate for Payer: EPIC Health Plan Senior |
$221.36
|
| Rate for Payer: Galaxy Health WC |
$470.40
|
| Rate for Payer: Global Benefits Group Commercial |
$332.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$498.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$387.39
|
| Rate for Payer: Multiplan Commercial |
$415.06
|
| Rate for Payer: Networks By Design Commercial |
$359.72
|
| Rate for Payer: Prime Health Services Commercial |
$470.40
|
| Rate for Payer: Riverside University Health System MISP |
$221.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$332.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$332.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.70
|
| Rate for Payer: United Healthcare All Other HMO |
$276.70
|
| Rate for Payer: United Healthcare HMO Rider |
$276.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$470.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.40
|
| Rate for Payer: Vantage Medical Group Senior |
$470.40
|
|
|
SUNITINIB MALATE 50 MG CAPSULE [70426]
|
Facility
|
IP
|
$963.40
|
|
|
Service Code
|
NDC 0069098038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$192.68 |
| Max. Negotiated Rate |
$867.06 |
| Rate for Payer: Adventist Health Commercial |
$192.68
|
| Rate for Payer: Blue Shield of California Commercial |
$772.65
|
| Rate for Payer: Blue Shield of California EPN |
$485.55
|
| Rate for Payer: Cash Price |
$433.53
|
| Rate for Payer: Central Health Plan Commercial |
$770.72
|
| Rate for Payer: Cigna of CA HMO |
$674.38
|
| Rate for Payer: Cigna of CA PPO |
$674.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$674.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.36
|
| Rate for Payer: EPIC Health Plan Senior |
$385.36
|
| Rate for Payer: Galaxy Health WC |
$818.89
|
| Rate for Payer: Global Benefits Group Commercial |
$578.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$867.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$611.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$568.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.68
|
| Rate for Payer: Multiplan Commercial |
$722.55
|
| Rate for Payer: Networks By Design Commercial |
$626.21
|
| Rate for Payer: Prime Health Services Commercial |
$818.89
|
|
|
SUNITINIB MALATE 50 MG CAPSULE [70426]
|
Facility
|
OP
|
$963.40
|
|
|
Service Code
|
NDC 0069098038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$192.68 |
| Max. Negotiated Rate |
$867.06 |
| Rate for Payer: Adventist Health Commercial |
$192.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$585.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$818.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$722.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$466.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$560.41
|
| Rate for Payer: Blue Shield of California Commercial |
$610.80
|
| Rate for Payer: Blue Shield of California EPN |
$384.40
|
| Rate for Payer: Cash Price |
$433.53
|
| Rate for Payer: Central Health Plan Commercial |
$770.72
|
| Rate for Payer: Cigna of CA HMO |
$674.38
|
| Rate for Payer: Cigna of CA PPO |
$674.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$818.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$818.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$818.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$674.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.36
|
| Rate for Payer: EPIC Health Plan Senior |
$385.36
|
| Rate for Payer: Galaxy Health WC |
$818.89
|
| Rate for Payer: Global Benefits Group Commercial |
$578.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$867.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$611.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$349.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$568.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$674.38
|
| Rate for Payer: Multiplan Commercial |
$722.55
|
| Rate for Payer: Networks By Design Commercial |
$626.21
|
| Rate for Payer: Prime Health Services Commercial |
$818.89
|
| Rate for Payer: Riverside University Health System MISP |
$385.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$578.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$578.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$481.70
|
| Rate for Payer: United Healthcare All Other HMO |
$481.70
|
| Rate for Payer: United Healthcare HMO Rider |
$481.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$481.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$818.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$818.89
|
| Rate for Payer: Vantage Medical Group Senior |
$818.89
|
|
|
SUPRACHOROIDAL SPACE INJECTION OF PHARMACOLOGIC AGENT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.18 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| 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 |
$671.50
|
| 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 |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
SUPRAHYOID LYMPHADENECTOMY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 38700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.18 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,540.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,394.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,540.37
|
| 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 |
$13,202.52
|
| 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 |
$12,810.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,394.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,540.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,091.61
|
| Rate for Payer: EPIC Health Plan Senior |
$9,394.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,006.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,540.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,956.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,444.10
|
| Rate for Payer: Multiplan WC |
$13,202.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8,540.37
|
| Rate for Payer: Preferred Health Network WC |
$13,471.96
|
| Rate for Payer: Prime Health Services Medicare |
$9,052.79
|
| Rate for Payer: Prime Health Services WC |
$13,067.80
|
| Rate for Payer: Riverside University Health System MISP |
$9,394.41
|
| 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 |
$8,540.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,394.41
|
| Rate for Payer: Vantage Medical Group Senior |
$8,540.37
|
|
|
SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITHOUT PLASTIC REPAIR
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$356.68 |
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$356.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.00
|
| 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
|
|
|
SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITH PLASTIC REPAIR
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$101.17 |
| 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 |
$101.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.76
|
| 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
|
|
|
SURGICAL LUBRICANT JELLY TOPICAL [112826]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
|
|
SURGICAL LUBRICANT JELLY TOPICAL [112826]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR SCAR (INCLUDING SUBCUTANEOUS TISSUES), OR INCISIONAL RELEASE OF SCAR CONTRACTURE, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR 1% OF BODY AREA OF INFANTS AND CHILDREN
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$522.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| 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 |
$1,239.24
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$112.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR SCAR (INCLUDING SUBCUTANEOUS TISSUES), OR INCISIONAL RELEASE OF SCAR CONTRACTURE, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR 1% OF BODY AREA OF INFANTS AND CHILDREN
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.85 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$950.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| 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 |
$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 |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
SURGICAL TECHNIQUES REQUIRING USE OF ROBOTIC SURGICAL SYSTEM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT S2900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
|
|
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); INTERSPHINCTERIC
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 46275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,569.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,551.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$608.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$672.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,997.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,783.75
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Preferred Health Network WC |
$5,665.21
|
| Rate for Payer: Prime Health Services Medicare |
$3,784.16
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,926.96
|
| 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 |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 46270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$258.71 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,569.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,551.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$258.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$285.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,997.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,783.75
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Preferred Health Network WC |
$5,665.21
|
| Rate for Payer: Prime Health Services Medicare |
$3,784.16
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,926.96
|
| 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 |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); TRANSSPHINCTERIC, SUPRASPHINCTERIC, EXTRASPHINCTERIC OR MULTIPLE, INCLUDING PLACEMENT OF SETON, WHEN PERFORMED
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 46280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,569.96 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,569.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| 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 |
$5,551.91
|
| 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 |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,997.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,783.75
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Preferred Health Network WC |
$5,665.21
|
| Rate for Payer: Prime Health Services Medicare |
$3,784.16
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,926.96
|
| 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 |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
SUTURE OF DIGITAL NERVE, HAND OR FOOT; 1 NERVE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,511.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| 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 |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| 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 |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
SUZETRIGINE 50 MG TABLET [244603]
|
Facility
|
OP
|
$18.60
|
|
|
Service Code
|
HCPCS C9818
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.82
|
| Rate for Payer: Blue Shield of California Commercial |
$11.79
|
| Rate for Payer: Blue Shield of California EPN |
$7.42
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Central Health Plan Commercial |
$14.88
|
| Rate for Payer: Cigna of CA HMO |
$13.02
|
| Rate for Payer: Cigna of CA PPO |
$13.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$15.81
|
| Rate for Payer: Global Benefits Group Commercial |
$11.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$13.95
|
| Rate for Payer: Networks By Design Commercial |
$9.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$15.81
|
| Rate for Payer: Prime Health Services Medicare |
$0.41
|
| Rate for Payer: Riverside University Health System MISP |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
SUZETRIGINE 50 MG TABLET [244603]
|
Facility
|
IP
|
$18.60
|
|
|
Service Code
|
HCPCS C9818
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California EPN |
$9.37
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Central Health Plan Commercial |
$14.88
|
| Rate for Payer: Cigna of CA HMO |
$13.02
|
| Rate for Payer: Cigna of CA PPO |
$13.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.81
|
| Rate for Payer: Global Benefits Group Commercial |
$11.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$13.95
|
| Rate for Payer: Networks By Design Commercial |
$9.30
|
| Rate for Payer: Prime Health Services Commercial |
$15.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$22,939.64
|
|
|
Service Code
|
MSDRG 312
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$22,939.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,939.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,818.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,745.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,322.57
|
| Rate for Payer: EPIC Health Plan Senior |
$14,215.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,922.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,091.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,316.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,922.77
|
| Rate for Payer: Prime Health Services Medicare |
$13,698.14
|
| 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
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$13,698.51
|
|
|
Service Code
|
APR-DRG 2043
|
| Min. Negotiated Rate |
$8,651.69 |
| Max. Negotiated Rate |
$13,698.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,651.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,309.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,698.51
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$8,906.74
|
|
|
Service Code
|
APR-DRG 2041
|
| Min. Negotiated Rate |
$5,625.31 |
| Max. Negotiated Rate |
$8,906.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,625.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,703.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,906.74
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$22,037.24
|
|
|
Service Code
|
APR-DRG 2044
|
| Min. Negotiated Rate |
$13,918.26 |
| Max. Negotiated Rate |
$22,037.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,918.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,585.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,037.24
|
|
