|
TROPICAMIDE 0.5 % EYE DROPS [8249]
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
NDC 6131435401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.11
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
|
|
TROPICAMIDE 0.5 % EYE DROPS [8249]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
NDC 6131435401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.11
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: Riverside University Health System MISP |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1.45
|
|
|
TROPICAMIDE 1 % EYE DROPS [8250]
|
Facility
|
OP
|
$0.68
|
|
|
Service Code
|
NDC 7006912101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.58
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.58
|
| Rate for Payer: Riverside University Health System MISP |
$0.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Vantage Medical Group Senior |
$0.58
|
|
|
TROPICAMIDE 1 % EYE DROPS [8250]
|
Facility
|
IP
|
$0.68
|
|
|
Service Code
|
NDC 7006912101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.58
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.58
|
|
|
TROPICAMIDE 1 % EYE DROPS [8250]
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
NDC 6131435502
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.23
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Central Health Plan Commercial |
$1.96
|
| Rate for Payer: Cigna of CA HMO |
$1.72
|
| Rate for Payer: Cigna of CA PPO |
$1.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.08
|
| Rate for Payer: Global Benefits Group Commercial |
$1.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.08
|
|
|
TROPICAMIDE 1 % EYE DROPS [8250]
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
NDC 6131435502
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Central Health Plan Commercial |
$1.96
|
| Rate for Payer: Cigna of CA HMO |
$1.72
|
| Rate for Payer: Cigna of CA PPO |
$1.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.08
|
| Rate for Payer: Global Benefits Group Commercial |
$1.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.08
|
| Rate for Payer: Vantage Medical Group Senior |
$2.08
|
|
|
TROPICAMIDE 1 %-PROPARACAINE 0.5 %-PE 2.5 %-KETOROLAC 0.5 % EYE DROPS [223020]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.12 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$13.47
|
| Rate for Payer: Blue Shield of California EPN |
$8.47
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Central Health Plan Commercial |
$13.44
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$11.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Networks By Design Commercial |
$8.40
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.31
|
| Rate for Payer: United Healthcare All Other HMO |
$6.14
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
|
|
TROPICAMIDE 1 %-PROPARACAINE 0.5 %-PE 2.5 %-KETOROLAC 0.5 % EYE DROPS [223020]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.12 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.65
|
| Rate for Payer: Blue Shield of California EPN |
$6.70
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Central Health Plan Commercial |
$13.44
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$11.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Networks By Design Commercial |
$8.40
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: Riverside University Health System MISP |
$6.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.31
|
| Rate for Payer: United Healthcare All Other HMO |
$6.14
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$14.28
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE [88317]
|
Facility
|
OP
|
$207.91
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$187.12 |
| Rate for Payer: Adventist Health Commercial |
$41.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$131.81
|
| Rate for Payer: Blue Shield of California EPN |
$82.96
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Central Health Plan Commercial |
$166.33
|
| Rate for Payer: Cigna of CA HMO |
$145.54
|
| Rate for Payer: Cigna of CA PPO |
$145.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.94
|
| Rate for Payer: EPIC Health Plan Senior |
$11.96
|
| Rate for Payer: Galaxy Health WC |
$176.72
|
| Rate for Payer: Global Benefits Group Commercial |
$124.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$187.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.57
|
| Rate for Payer: Multiplan Commercial |
$155.93
|
| Rate for Payer: Networks By Design Commercial |
$103.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.87
|
| Rate for Payer: Prime Health Services Commercial |
$176.72
|
| Rate for Payer: Prime Health Services Medicare |
$11.52
|
| Rate for Payer: Riverside University Health System MISP |
$11.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.03
|
| Rate for Payer: United Healthcare All Other HMO |
$75.95
|
| Rate for Payer: United Healthcare HMO Rider |
$74.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Vantage Medical Group Senior |
$11.96
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE [88317]
|
Facility
|
IP
|
$207.91
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$187.12 |
| Rate for Payer: Adventist Health Commercial |
$41.58
|
| Rate for Payer: Blue Shield of California Commercial |
$166.74
|
| Rate for Payer: Blue Shield of California EPN |
$104.79
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Central Health Plan Commercial |
$166.33
|
| Rate for Payer: Cigna of CA HMO |
$145.54
|
| Rate for Payer: Cigna of CA PPO |
$145.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.16
|
| Rate for Payer: EPIC Health Plan Senior |
$83.16
|
| Rate for Payer: Galaxy Health WC |
$176.72
|
| Rate for Payer: Global Benefits Group Commercial |
$124.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$187.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.58
|
| Rate for Payer: Multiplan Commercial |
$155.93
|
| Rate for Payer: Networks By Design Commercial |
$103.95
|
| Rate for Payer: Prime Health Services Commercial |
$176.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.03
|
| Rate for Payer: United Healthcare All Other HMO |
$75.95
|
| Rate for Payer: United Healthcare HMO Rider |
$74.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.09
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
|
IP
|
$117.98
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
901700020
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$106.18 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Adventist Health Commercial |
$30.28
|
| Rate for Payer: Cash Price |
$68.13
|
| Rate for Payer: Cash Price |
$53.09
|
| Rate for Payer: Central Health Plan Commercial |
$121.11
|
| Rate for Payer: Central Health Plan Commercial |
$94.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.19
|
| Rate for Payer: EPIC Health Plan Senior |
$47.19
|
| Rate for Payer: EPIC Health Plan Senior |
$60.56
|
| Rate for Payer: Galaxy Health WC |
$128.68
|
| Rate for Payer: Galaxy Health WC |
$100.28
|
| Rate for Payer: Global Benefits Group Commercial |
$70.79
|
| Rate for Payer: Global Benefits Group Commercial |
$90.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Multiplan Commercial |
$113.54
|
| Rate for Payer: Multiplan Commercial |
$88.48
|
| Rate for Payer: Networks By Design Commercial |
$76.69
|
| Rate for Payer: Networks By Design Commercial |
$98.40
|
| Rate for Payer: Prime Health Services Commercial |
$100.28
|
| Rate for Payer: Prime Health Services Commercial |
$128.68
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
|
OP
|
$117.98
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
901700020
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$106.18 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Adventist Health Commercial |
$30.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.97
|
| Rate for Payer: Blue Shield of California Commercial |
$74.33
|
| Rate for Payer: Blue Shield of California Commercial |
$95.38
|
| Rate for Payer: Blue Shield of California EPN |
$60.10
|
| Rate for Payer: Blue Shield of California EPN |
$46.84
|
| Rate for Payer: Cash Price |
$68.13
|
| Rate for Payer: Cash Price |
$68.13
|
| Rate for Payer: Cash Price |
$53.09
|
| Rate for Payer: Cash Price |
$53.09
|
| Rate for Payer: Central Health Plan Commercial |
$121.11
|
| Rate for Payer: Central Health Plan Commercial |
$94.38
|
| Rate for Payer: Cigna of CA HMO |
$75.51
|
| Rate for Payer: Cigna of CA HMO |
$96.89
|
| Rate for Payer: Cigna of CA PPO |
$87.31
|
| Rate for Payer: Cigna of CA PPO |
$112.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$128.68
|
| Rate for Payer: Galaxy Health WC |
$100.28
|
| Rate for Payer: Global Benefits Group Commercial |
$90.83
|
| Rate for Payer: Global Benefits Group Commercial |
$70.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$88.48
|
| Rate for Payer: Multiplan Commercial |
$113.54
|
| Rate for Payer: Networks By Design Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$76.69
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Prime Health Services Commercial |
$100.28
|
| Rate for Payer: Prime Health Services Commercial |
$128.68
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
TUCATINIB 150 MG TABLET [227737]
|
Facility
|
IP
|
$271.90
|
|
|
Service Code
|
NDC 5114400212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$54.38 |
| Max. Negotiated Rate |
$244.71 |
| Rate for Payer: Adventist Health Commercial |
$54.38
|
| Rate for Payer: Blue Shield of California Commercial |
$218.06
|
| Rate for Payer: Blue Shield of California EPN |
$137.04
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Central Health Plan Commercial |
$217.52
|
| Rate for Payer: Cigna of CA HMO |
$190.33
|
| Rate for Payer: Cigna of CA PPO |
$190.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.76
|
| Rate for Payer: EPIC Health Plan Senior |
$108.76
|
| Rate for Payer: Galaxy Health WC |
$231.12
|
| Rate for Payer: Global Benefits Group Commercial |
$163.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.38
|
| Rate for Payer: Multiplan Commercial |
$203.93
|
| Rate for Payer: Networks By Design Commercial |
$176.74
|
| Rate for Payer: Prime Health Services Commercial |
$231.12
|
|
|
TUCATINIB 150 MG TABLET [227737]
|
Facility
|
OP
|
$271.90
|
|
|
Service Code
|
NDC 5114400212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$54.38 |
| Max. Negotiated Rate |
$244.71 |
| Rate for Payer: Adventist Health Commercial |
$54.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$203.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$131.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.16
|
| Rate for Payer: Blue Shield of California Commercial |
$172.38
|
| Rate for Payer: Blue Shield of California EPN |
$108.49
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Central Health Plan Commercial |
$217.52
|
| Rate for Payer: Cigna of CA HMO |
$190.33
|
| Rate for Payer: Cigna of CA PPO |
$190.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.76
|
| Rate for Payer: EPIC Health Plan Senior |
$108.76
|
| Rate for Payer: Galaxy Health WC |
$231.12
|
| Rate for Payer: Global Benefits Group Commercial |
$163.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$190.33
|
| Rate for Payer: Multiplan Commercial |
$203.93
|
| Rate for Payer: Networks By Design Commercial |
$176.74
|
| Rate for Payer: Prime Health Services Commercial |
$231.12
|
| Rate for Payer: Riverside University Health System MISP |
$108.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.95
|
| Rate for Payer: United Healthcare All Other HMO |
$135.95
|
| Rate for Payer: United Healthcare HMO Rider |
$135.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.12
|
| Rate for Payer: Vantage Medical Group Senior |
$231.12
|
|
|
TUCATINIB 50 MG TABLET [227736]
|
Facility
|
IP
|
$135.22
|
|
|
Service Code
|
NDC 5114400160
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Adventist Health Commercial |
$27.04
|
| Rate for Payer: Blue Shield of California Commercial |
$108.45
|
| Rate for Payer: Blue Shield of California EPN |
$68.15
|
| Rate for Payer: Cash Price |
$60.85
|
| Rate for Payer: Central Health Plan Commercial |
$108.18
|
| Rate for Payer: Cigna of CA HMO |
$94.65
|
| Rate for Payer: Cigna of CA PPO |
$94.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.09
|
| Rate for Payer: EPIC Health Plan Senior |
$54.09
|
| Rate for Payer: Galaxy Health WC |
$114.94
|
| Rate for Payer: Global Benefits Group Commercial |
$81.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.04
|
| Rate for Payer: Multiplan Commercial |
$101.42
|
| Rate for Payer: Networks By Design Commercial |
$87.89
|
| Rate for Payer: Prime Health Services Commercial |
$114.94
|
|
|
TUCATINIB 50 MG TABLET [227736]
|
Facility
|
OP
|
$135.22
|
|
|
Service Code
|
NDC 5114400160
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Adventist Health Commercial |
$27.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.66
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$53.95
|
| Rate for Payer: Cash Price |
$60.85
|
| Rate for Payer: Central Health Plan Commercial |
$108.18
|
| Rate for Payer: Cigna of CA HMO |
$94.65
|
| Rate for Payer: Cigna of CA PPO |
$94.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.09
|
| Rate for Payer: EPIC Health Plan Senior |
$54.09
|
| Rate for Payer: Galaxy Health WC |
$114.94
|
| Rate for Payer: Global Benefits Group Commercial |
$81.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.65
|
| Rate for Payer: Multiplan Commercial |
$101.42
|
| Rate for Payer: Networks By Design Commercial |
$87.89
|
| Rate for Payer: Prime Health Services Commercial |
$114.94
|
| Rate for Payer: Riverside University Health System MISP |
$54.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.61
|
| Rate for Payer: United Healthcare All Other HMO |
$67.61
|
| Rate for Payer: United Healthcare HMO Rider |
$67.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.94
|
| Rate for Payer: Vantage Medical Group Senior |
$114.94
|
|
|
TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION OF PERFORATION FOR CLOSURE, WITH OR WITHOUT PATCH
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$245.25 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,995.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| 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 |
$2,998.82
|
| 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 |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,793.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Medicare |
$2,115.34
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,195.16
|
| 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 |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
TYMPANOLYSIS, TRANSCANAL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.31 |
| 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 |
$65.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.14
|
| 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 |
$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 |
$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
|
|
|
TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY, ATTICOTOMY, MIDDLE EAR SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION AND SYNTHETIC PROSTHESIS (EG, PARTIAL OSSICULAR REPLACEMENT PROSTHESIS [PORP], TOTAL OSSICULAR REPLACEMENT PROSTHESIS [TORP])
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69637
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,921.07 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,921.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,122.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); RADICAL OR COMPLETE, WITH OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69646
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,740.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,740.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,922.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); RADICAL OR COMPLETE, WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$324.01 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$324.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$357.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH INTACT OR RECONSTRUCTED WALL, WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$307.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$307.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69631
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$281.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.48 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,995.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| 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 |
$2,998.82
|
| 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 |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$207.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$229.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,793.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Medicare |
$2,115.34
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
