|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Blue Shield of California Commercial |
$55.12
|
| Rate for Payer: Blue Shield of California EPN |
$39.25
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.70
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$40.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.42
|
| Rate for Payer: BCBS Transplant Transplant |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$46.23
|
| Rate for Payer: Blue Shield of California EPN |
$35.94
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: Cigna of CA HMO |
$47.04
|
| Rate for Payer: Cigna of CA PPO |
$54.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$55.12
|
| Rate for Payer: IEHP medi-cal |
$25.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.70
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
| Rate for Payer: Riverside University Health MISP |
$29.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.75
|
| Rate for Payer: United Healthcare All Other HMO |
$36.75
|
| Rate for Payer: United Healthcare HMO Rider |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$69.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.59
|
| Rate for Payer: BCBS Transplant Transplant |
$46.30
|
| Rate for Payer: Blue Shield of California Commercial |
$48.54
|
| Rate for Payer: Blue Shield of California EPN |
$37.74
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Central Health Plan Commercial |
$61.74
|
| Rate for Payer: Cigna of CA HMO |
$49.39
|
| Rate for Payer: Cigna of CA PPO |
$57.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.87
|
| Rate for Payer: Galaxy Health WC |
$65.59
|
| Rate for Payer: Global Benefits Group Commercial |
$46.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$57.88
|
| Rate for Payer: IEHP medi-cal |
$27.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.43
|
| Rate for Payer: Multiplan Commercial |
$57.88
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$65.59
|
| Rate for Payer: Riverside University Health MISP |
$30.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.58
|
| Rate for Payer: United Healthcare All Other HMO |
$38.58
|
| Rate for Payer: United Healthcare HMO Rider |
$38.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: Vantage Medical Group Senior |
$65.59
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$66.20 |
| Rate for Payer: Blue Shield of California Commercial |
$55.16
|
| Rate for Payer: Blue Shield of California EPN |
$39.28
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Central Health Plan Commercial |
$58.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: Galaxy Health WC |
$62.52
|
| Rate for Payer: Global Benefits Group Commercial |
$44.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.71
|
| Rate for Payer: Multiplan Commercial |
$55.16
|
| Rate for Payer: Networks By Design Commercial |
$47.81
|
| Rate for Payer: Prime Health Services Commercial |
$62.52
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-10
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$40.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.42
|
| Rate for Payer: BCBS Transplant Transplant |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$46.23
|
| Rate for Payer: Blue Shield of California EPN |
$35.94
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: Cigna of CA HMO |
$47.04
|
| Rate for Payer: Cigna of CA PPO |
$54.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$55.12
|
| Rate for Payer: IEHP medi-cal |
$25.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.70
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
| Rate for Payer: Riverside University Health MISP |
$29.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.75
|
| Rate for Payer: United Healthcare All Other HMO |
$36.75
|
| Rate for Payer: United Healthcare HMO Rider |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$69.45 |
| Rate for Payer: Blue Shield of California Commercial |
$57.88
|
| Rate for Payer: Blue Shield of California EPN |
$41.21
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Central Health Plan Commercial |
$61.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.87
|
| Rate for Payer: Galaxy Health WC |
$65.59
|
| Rate for Payer: Global Benefits Group Commercial |
$46.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.43
|
| Rate for Payer: Multiplan Commercial |
$57.88
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$65.59
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-10
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Blue Shield of California Commercial |
$55.12
|
| Rate for Payer: Blue Shield of California EPN |
$39.25
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.70
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-03
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$66.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$40.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.45
|
| Rate for Payer: BCBS Transplant Transplant |
$44.13
|
| Rate for Payer: Blue Shield of California Commercial |
$46.26
|
| Rate for Payer: Blue Shield of California EPN |
$35.97
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Central Health Plan Commercial |
$58.84
|
| Rate for Payer: Cigna of CA HMO |
$47.07
|
| Rate for Payer: Cigna of CA PPO |
$54.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.42
|
| Rate for Payer: Galaxy Health WC |
$62.52
|
| Rate for Payer: Global Benefits Group Commercial |
$44.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$55.16
|
| Rate for Payer: IEHP medi-cal |
$25.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.71
|
| Rate for Payer: Multiplan Commercial |
$55.16
|
| Rate for Payer: Networks By Design Commercial |
$47.81
|
| Rate for Payer: Prime Health Services Commercial |
$62.52
|
| Rate for Payer: Riverside University Health MISP |
$29.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$36.78
|
| Rate for Payer: United Healthcare HMO Rider |
$36.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.52
|
| Rate for Payer: Vantage Medical Group Senior |
$62.52
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$69.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.59
|
| Rate for Payer: BCBS Transplant Transplant |
$46.30
|
| Rate for Payer: Blue Shield of California Commercial |
$48.54
|
| Rate for Payer: Blue Shield of California EPN |
$37.74
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Central Health Plan Commercial |
$61.74
|
| Rate for Payer: Cigna of CA HMO |
$49.39
|
| Rate for Payer: Cigna of CA PPO |
$57.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.87
|
| Rate for Payer: Galaxy Health WC |
$65.59
|
| Rate for Payer: Global Benefits Group Commercial |
$46.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$57.88
|
| Rate for Payer: IEHP medi-cal |
$27.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.43
|
| Rate for Payer: Multiplan Commercial |
$57.88
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$65.59
|
| Rate for Payer: Riverside University Health MISP |
$30.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.58
|
| Rate for Payer: United Healthcare All Other HMO |
$38.58
|
| Rate for Payer: United Healthcare HMO Rider |
$38.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: Vantage Medical Group Senior |
$65.59
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
IP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-99
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Blue Shield of California Commercial |
$110.32
|
| Rate for Payer: Blue Shield of California EPN |
$78.55
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Central Health Plan Commercial |
$117.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.84
|
| Rate for Payer: Galaxy Health WC |
$125.04
|
| Rate for Payer: Global Benefits Group Commercial |
$88.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.42
|
| Rate for Payer: Multiplan Commercial |
$110.32
|
| Rate for Payer: Networks By Design Commercial |
$95.62
|
| Rate for Payer: Prime Health Services Commercial |
$125.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
OP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-05
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$125.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$80.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$80.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.91
|
| Rate for Payer: BCBS Transplant Transplant |
$88.26
|
| Rate for Payer: Blue Shield of California Commercial |
$92.53
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Central Health Plan Commercial |
$117.68
|
| Rate for Payer: Cigna of CA HMO |
$94.14
|
| Rate for Payer: Cigna of CA PPO |
$108.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.84
|
| Rate for Payer: Galaxy Health WC |
$125.04
|
| Rate for Payer: Global Benefits Group Commercial |
$88.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$110.32
|
| Rate for Payer: IEHP medi-cal |
$51.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.42
|
| Rate for Payer: Multiplan Commercial |
$110.32
|
| Rate for Payer: Networks By Design Commercial |
$95.62
|
| Rate for Payer: Prime Health Services Commercial |
$125.04
|
| Rate for Payer: Riverside University Health MISP |
$58.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.55
|
| Rate for Payer: United Healthcare All Other HMO |
$73.55
|
| Rate for Payer: United Healthcare HMO Rider |
$73.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
OP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-99
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$125.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$80.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$80.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.91
|
| Rate for Payer: BCBS Transplant Transplant |
$88.26
|
| Rate for Payer: Blue Shield of California Commercial |
$92.53
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Central Health Plan Commercial |
$117.68
|
| Rate for Payer: Cigna of CA HMO |
$94.14
|
| Rate for Payer: Cigna of CA PPO |
$108.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.84
|
| Rate for Payer: Galaxy Health WC |
$125.04
|
| Rate for Payer: Global Benefits Group Commercial |
$88.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$110.32
|
| Rate for Payer: IEHP medi-cal |
$51.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.42
|
| Rate for Payer: Multiplan Commercial |
$110.32
|
| Rate for Payer: Networks By Design Commercial |
$95.62
|
| Rate for Payer: Prime Health Services Commercial |
$125.04
|
| Rate for Payer: Riverside University Health MISP |
$58.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.55
|
| Rate for Payer: United Healthcare All Other HMO |
$73.55
|
| Rate for Payer: United Healthcare HMO Rider |
$73.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
IP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-05
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Blue Shield of California Commercial |
$110.32
|
| Rate for Payer: Blue Shield of California EPN |
$78.55
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Central Health Plan Commercial |
$117.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.84
|
| Rate for Payer: Galaxy Health WC |
$125.04
|
| Rate for Payer: Global Benefits Group Commercial |
$88.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.42
|
| Rate for Payer: Multiplan Commercial |
$110.32
|
| Rate for Payer: Networks By Design Commercial |
$95.62
|
| Rate for Payer: Prime Health Services Commercial |
$125.04
|
|
|
Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session
|
Facility
OP
|
$51,156.00
|
|
|
Service Code
|
CPT 54410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$51,156.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,203.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,203.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$34,456.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$25,203.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,024.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$25,203.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41,333.41
|
| Rate for Payer: IEHP medi-cal |
$41,585.44
|
| Rate for Payer: IEHP Medicare Advantage |
$25,203.30
|
| Rate for Payer: Innovage PACE Commercial |
$37,804.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,203.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,772.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,772.42
|
| Rate for Payer: Multiplan WC |
$34,456.53
|
| Rate for Payer: Preferred Health Network WC |
$35,159.72
|
| Rate for Payer: Prime Health Services Medicare |
$26,715.50
|
| Rate for Payer: Prime Health Services WC |
$34,104.93
|
| Rate for Payer: Riverside University Health MISP |
$27,723.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Vantage Medical Group Senior |
$25,203.30
|
|
|
Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation
|
Facility
OP
|
$7,027.00
|
|
|
Service Code
|
CPT 50387
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,544.87 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: IEHP medi-cal |
$4,199.04
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Innovage PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health MISP |
$2,799.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 53447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,203.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,203.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$34,456.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$25,203.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,024.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$25,203.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41,333.41
|
| Rate for Payer: IEHP medi-cal |
$41,585.44
|
| Rate for Payer: IEHP Medicare Advantage |
$25,203.30
|
| Rate for Payer: Innovage PACE Commercial |
$37,804.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,203.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,772.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,772.42
|
| Rate for Payer: Multiplan WC |
$34,456.53
|
| Rate for Payer: Preferred Health Network WC |
$35,159.72
|
| Rate for Payer: Prime Health Services Medicare |
$26,715.50
|
| Rate for Payer: Prime Health Services WC |
$34,104.93
|
| Rate for Payer: Riverside University Health MISP |
$27,723.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Vantage Medical Group Senior |
$25,203.30
|
|
|
Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia)
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 21029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: IEHP medi-cal |
$6,637.44
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Innovage PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health MISP |
$4,424.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
Removal foreign body from external auditory canal; with general anesthesia
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 69205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,025.69 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$3,342.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Removal impacted cerumen requiring instrumentation, unilateral
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: IEHP medi-cal |
$126.09
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Innovage PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health MISP |
$84.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
Removal, non-biodegradable drug delivery implant
|
Facility
OP
|
$2,901.00
|
|
|
Service Code
|
CPT 11982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$497.82 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$497.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: IEHP medi-cal |
$821.40
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Innovage PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Riverside University Health MISP |
$547.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
Removal of anal seton, other marker
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 46030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,474.42 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,474.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,474.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,418.05
|
| Rate for Payer: IEHP medi-cal |
$2,432.79
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Innovage PACE Commercial |
$2,211.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,975.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Prime Health Services Medicare |
$1,562.89
|
| Rate for Payer: Riverside University Health MISP |
$1,621.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
Removal of blood clot, anterior segment of eye
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 65930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,911.63 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,911.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: IEHP medi-cal |
$4,804.19
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Innovage PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Riverside University Health MISP |
$3,202.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Removal of corneal epithelium; with application of chelating agent (eg, EDTA)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 65436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Removal of embedded foreign body, vestibule of mouth; complicated
|
Facility
OP
|
$6,248.00
|
|
|
Service Code
|
CPT 40805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$687.44 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$687.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: IEHP medi-cal |
$1,134.28
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Innovage PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Riverside University Health MISP |
$756.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
Removal of fecal impaction or foreign body (separate procedure) under anesthesia
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 45915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,474.42 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,474.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,474.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,418.05
|
| Rate for Payer: IEHP medi-cal |
$2,432.79
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Innovage PACE Commercial |
$2,211.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,975.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Prime Health Services Medicare |
$1,562.89
|
| Rate for Payer: Riverside University Health MISP |
$1,621.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
