|
TRANEXAMIC ACID 650 MG TABLET [104576]
|
Facility
|
IP
|
$5.15
|
|
|
Service Code
|
NDC 6068775021
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Central Health Plan Commercial |
$4.12
|
| Rate for Payer: Cigna of CA HMO |
$3.60
|
| Rate for Payer: Cigna of CA PPO |
$3.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: EPIC Health Plan Senior |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$4.38
|
| Rate for Payer: Global Benefits Group Commercial |
$3.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: Networks By Design Commercial |
$3.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.38
|
|
|
TRANEXAMIC ACID 650 MG TABLET [104576]
|
Facility
|
OP
|
$5.15
|
|
|
Service Code
|
NDC 6068775011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Central Health Plan Commercial |
$4.12
|
| Rate for Payer: Cigna of CA HMO |
$3.60
|
| Rate for Payer: Cigna of CA PPO |
$3.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: EPIC Health Plan Senior |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$4.38
|
| Rate for Payer: Global Benefits Group Commercial |
$3.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: Networks By Design Commercial |
$3.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.38
|
| Rate for Payer: Riverside University Health System MISP |
$2.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.58
|
| Rate for Payer: United Healthcare All Other HMO |
$2.58
|
| Rate for Payer: United Healthcare HMO Rider |
$2.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.38
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
TRANEXAMIC ACID 650 MG TABLET [104576]
|
Facility
|
IP
|
$5.15
|
|
|
Service Code
|
NDC 6068775011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Central Health Plan Commercial |
$4.12
|
| Rate for Payer: Cigna of CA HMO |
$3.60
|
| Rate for Payer: Cigna of CA PPO |
$3.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: EPIC Health Plan Senior |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$4.38
|
| Rate for Payer: Global Benefits Group Commercial |
$3.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: Networks By Design Commercial |
$3.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.38
|
|
|
TRANEXAMIC ACID 650 MG TABLET [104576]
|
Facility
|
OP
|
$5.15
|
|
|
Service Code
|
NDC 6068775021
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Central Health Plan Commercial |
$4.12
|
| Rate for Payer: Cigna of CA HMO |
$3.60
|
| Rate for Payer: Cigna of CA PPO |
$3.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: EPIC Health Plan Senior |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$4.38
|
| Rate for Payer: Global Benefits Group Commercial |
$3.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: Networks By Design Commercial |
$3.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.38
|
| Rate for Payer: Riverside University Health System MISP |
$2.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.58
|
| Rate for Payer: United Healthcare All Other HMO |
$2.58
|
| Rate for Payer: United Healthcare HMO Rider |
$2.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.38
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
TRANEXAMIC ACID ORAL SOLUTION (IV FORM) 5% (50 MG/ML) [40820838]
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 9940820838
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Central Health Plan Commercial |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
| Rate for Payer: Riverside University Health System MISP |
$0.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.82
|
| Rate for Payer: Vantage Medical Group Senior |
$0.82
|
|
|
TRANEXAMIC ACID ORAL SOLUTION (IV FORM) 5% (50 MG/ML) [40820838]
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 9940820838
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Central Health Plan Commercial |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
|
|
TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 37200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,156.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| 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 |
$10,943.70
|
| 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 |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$236.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Medicare |
$7,586.27
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,872.55
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64772
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$697.34 |
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| 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 |
$697.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$770.32
|
| 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 |
$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 |
$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
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$15,336.04
|
|
|
Service Code
|
APR-DRG 0473
|
| Min. Negotiated Rate |
$9,685.92 |
| Max. Negotiated Rate |
$15,336.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,685.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,542.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,336.04
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$12,135.49
|
|
|
Service Code
|
APR-DRG 0472
|
| Min. Negotiated Rate |
$7,664.52 |
| Max. Negotiated Rate |
$12,135.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,664.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,133.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,135.49
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$23,749.32
|
|
|
Service Code
|
APR-DRG 0474
|
| Min. Negotiated Rate |
$14,999.57 |
| Max. Negotiated Rate |
$23,749.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,999.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,874.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,749.32
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$10,530.18
|
|
|
Service Code
|
APR-DRG 0471
|
| Min. Negotiated Rate |
$6,650.64 |
| Max. Negotiated Rate |
$10,530.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,650.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,925.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,530.18
|
|
|
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC
|
Facility
|
IP
|
$21,023.62
|
|
|
Service Code
|
MSDRG 069
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$21,023.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,023.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,580.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,013.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,665.84
|
| Rate for Payer: EPIC Health Plan Senior |
$13,110.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,918.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,686.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,971.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,918.69
|
| Rate for Payer: Prime Health Services Medicare |
$12,633.81
|
| 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
|
|
|
TRANSLUMINAL BALLOON ANGIOPLASTY, CENTRAL DIALYSIS SEGMENT, PERFORMED THROUGH DIALYSIS CIRCUIT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION REQUIRED TO PERFORM THE ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 36907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,144.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,264.77
|
| 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
|
|
|
TRANSPOSITION PROCEDURE (EG, FOR PARETIC EXTRAOCULAR MUSCLE), ANY EXTRAOCULAR MUSCLE (SPECIFY) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,280.71 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,896.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,896.17
|
| 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 |
$10,291.67
|
| 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 |
$10,344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,585.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,896.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,378.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7,585.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,309.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,280.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,654.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,240.87
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Preferred Health Network WC |
$10,501.70
|
| Rate for Payer: Prime Health Services Medicare |
$7,309.94
|
| Rate for Payer: Prime Health Services WC |
$10,186.65
|
| Rate for Payer: Riverside University Health System MISP |
$7,585.79
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,896.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6,896.17
|
|
|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
|
IP
|
$40,847.09
|
|
|
Service Code
|
MSDRG 669
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$40,847.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,847.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,385.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,940.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,806.29
|
| Rate for Payer: EPIC Health Plan Senior |
$24,537.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,306.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,229.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,891.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,306.84
|
| Rate for Payer: Prime Health Services Medicare |
$23,645.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$76,851.48
|
|
|
Service Code
|
MSDRG 668
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$76,851.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76,851.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49,642.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69,501.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$67,937.73
|
| Rate for Payer: EPIC Health Plan Senior |
$45,291.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,174.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57,644.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55,173.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$41,174.38
|
| Rate for Payer: Prime Health Services Medicare |
$43,644.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$25,721.56
|
|
|
Service Code
|
MSDRG 670
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$25,721.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,721.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,615.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,261.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,727.94
|
| Rate for Payer: EPIC Health Plan Senior |
$15,818.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,380.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,132.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,269.96
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,380.57
|
| Rate for Payer: Prime Health Services Medicare |
$15,243.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$26,734.35
|
|
|
Service Code
|
APR-DRG 4823
|
| Min. Negotiated Rate |
$16,884.85 |
| Max. Negotiated Rate |
$26,734.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,884.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,121.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,734.35
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$40,271.72
|
|
|
Service Code
|
APR-DRG 4824
|
| Min. Negotiated Rate |
$25,434.77 |
| Max. Negotiated Rate |
$40,271.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,434.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30,309.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,271.72
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$11,690.36
|
|
|
Service Code
|
APR-DRG 4821
|
| Min. Negotiated Rate |
$7,383.38 |
| Max. Negotiated Rate |
$11,690.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,383.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,798.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,690.36
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$16,417.67
|
|
|
Service Code
|
APR-DRG 4822
|
| Min. Negotiated Rate |
$10,369.06 |
| Max. Negotiated Rate |
$16,417.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,369.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,356.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,417.67
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
|
IP
|
$39,567.98
|
|
|
Service Code
|
MSDRG 713
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$39,567.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,567.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,559.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,783.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,700.31
|
| Rate for Payer: EPIC Health Plan Senior |
$23,800.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,636.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,291.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,992.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,636.55
|
| Rate for Payer: Prime Health Services Medicare |
$22,934.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$27,829.71
|
|
|
Service Code
|
MSDRG 714
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$27,829.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,829.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,976.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,168.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,550.78
|
| Rate for Payer: EPIC Health Plan Senior |
$17,033.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,485.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,679.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,750.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15,485.32
|
| Rate for Payer: Prime Health Services Medicare |
$16,414.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
