|
Transfer of tendon to restore intrinsic function; ring and small finger
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 26497
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 27691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: IEHP medi-cal |
$14,748.57
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Innovage PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health MISP |
$9,832.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 26480
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Transfer or transplant of tendon, palmar; without free tendon graft, each tendon
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 26485
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
TRANSIENT ISCHEMIA
|
Facility
IP
|
$18,009.95
|
|
|
Service Code
|
APR-DRG 0474
|
| Min. Negotiated Rate |
$15,113.24 |
| Max. Negotiated Rate |
$18,009.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,113.24
|
| Rate for Payer: IEHP medi-cal |
$18,009.95
|
|
|
TRANSIENT ISCHEMIA
|
Facility
IP
|
$11,070.52
|
|
|
Service Code
|
APR-DRG 0473
|
| Min. Negotiated Rate |
$9,289.94 |
| Max. Negotiated Rate |
$11,070.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,289.94
|
| Rate for Payer: IEHP medi-cal |
$11,070.52
|
|
|
TRANSIENT ISCHEMIA
|
Facility
IP
|
$8,814.76
|
|
|
Service Code
|
APR-DRG 0472
|
| Min. Negotiated Rate |
$7,397.00 |
| Max. Negotiated Rate |
$8,814.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,397.00
|
| Rate for Payer: IEHP medi-cal |
$8,814.76
|
|
|
TRANSIENT ISCHEMIA
|
Facility
IP
|
$7,722.93
|
|
|
Service Code
|
APR-DRG 0471
|
| Min. Negotiated Rate |
$6,480.78 |
| Max. Negotiated Rate |
$7,722.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,480.78
|
| Rate for Payer: IEHP medi-cal |
$7,722.93
|
|
|
Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein
|
Facility
OP
|
$27,445.00
|
|
|
Service Code
|
CPT 37248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,141.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$7,141.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,711.81
|
| Rate for Payer: IEHP medi-cal |
$11,783.23
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Innovage PACE Commercial |
$10,712.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,569.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Prime Health Services Medicare |
$7,569.83
|
| Rate for Payer: Riverside University Health MISP |
$7,855.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or stent
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 66174
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,080.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,620.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,588.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,080.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$5,080.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,620.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,858.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5,080.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,080.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,331.20
|
| Rate for Payer: IEHP medi-cal |
$8,382.00
|
| Rate for Payer: IEHP Medicare Advantage |
$5,080.00
|
| Rate for Payer: Innovage PACE Commercial |
$7,620.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,080.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,807.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,807.20
|
| Rate for Payer: Prime Health Services Medicare |
$5,384.80
|
| Rate for Payer: Riverside University Health MISP |
$5,588.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,620.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,588.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,080.00
|
|
|
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
|
$25,512.00
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,465.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$6,465.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,465.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,602.62
|
| Rate for Payer: IEHP medi-cal |
$10,667.27
|
| Rate for Payer: IEHP Medicare Advantage |
$6,465.01
|
| Rate for Payer: Innovage PACE Commercial |
$9,697.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,465.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,663.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,663.11
|
| Rate for Payer: Prime Health Services Medicare |
$6,852.91
|
| Rate for Payer: Riverside University Health MISP |
$7,111.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$8,511.77
|
|
|
Service Code
|
APR-DRG 4821
|
| Min. Negotiated Rate |
$7,142.75 |
| Max. Negotiated Rate |
$8,511.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,142.75
|
| Rate for Payer: IEHP medi-cal |
$8,511.77
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$10,409.81
|
|
|
Service Code
|
APR-DRG 4822
|
| Min. Negotiated Rate |
$8,735.51 |
| Max. Negotiated Rate |
$10,409.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,735.51
|
| Rate for Payer: IEHP medi-cal |
$10,409.81
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$31,504.39
|
|
|
Service Code
|
APR-DRG 4824
|
| Min. Negotiated Rate |
$26,437.25 |
| Max. Negotiated Rate |
$31,504.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,437.25
|
| Rate for Payer: IEHP medi-cal |
$31,504.39
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$18,932.27
|
|
|
Service Code
|
APR-DRG 4823
|
| Min. Negotiated Rate |
$15,887.22 |
| Max. Negotiated Rate |
$18,932.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,887.22
|
| Rate for Payer: IEHP medi-cal |
$18,932.27
|
|
|
Transurethral resection of bladder neck (separate procedure)
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 52500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [216113]
|
Facility
OP
|
$1,870.10
|
|
|
Service Code
|
CPT J9355
|
| Hospital Charge Code |
ERX216113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$1,683.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$80.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$498.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$100.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.43
|
| Rate for Payer: BCBS Transplant Transplant |
$1,122.06
|
| Rate for Payer: Blue Shield of California Commercial |
$137.14
|
| Rate for Payer: Blue Shield of California EPN |
$124.67
|
| Rate for Payer: Caremore Medicare Advantage |
$80.46
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.08
|
| Rate for Payer: Cigna of CA HMO |
$1,309.07
|
| Rate for Payer: Cigna of CA PPO |
$1,309.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$80.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.46
|
| Rate for Payer: Galaxy Health WC |
$1,589.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,683.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,402.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$131.96
|
| Rate for Payer: IEHP medi-cal |
$132.77
|
| Rate for Payer: IEHP Medicare Advantage |
$80.46
|
| Rate for Payer: Innovage PACE Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.82
|
| Rate for Payer: Multiplan Commercial |
$1,402.58
|
| Rate for Payer: Networks By Design Commercial |
$935.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.58
|
| Rate for Payer: Prime Health Services Medicare |
$85.29
|
| Rate for Payer: Riverside University Health MISP |
$88.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,122.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,122.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$935.05
|
| Rate for Payer: United Healthcare All Other HMO |
$935.05
|
| Rate for Payer: United Healthcare HMO Rider |
$935.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Vantage Medical Group Senior |
$80.46
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [216113]
|
Facility
IP
|
$1,870.10
|
|
|
Service Code
|
CPT J9355
|
| Hospital Charge Code |
ERX216113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$374.02 |
| Max. Negotiated Rate |
$1,683.09 |
| Rate for Payer: Blue Shield of California Commercial |
$1,402.58
|
| Rate for Payer: Blue Shield of California EPN |
$998.63
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.08
|
| Rate for Payer: Cigna of CA HMO |
$1,309.07
|
| Rate for Payer: Cigna of CA PPO |
$1,309.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$748.04
|
| Rate for Payer: Galaxy Health WC |
$1,589.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,683.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.02
|
| Rate for Payer: Multiplan Commercial |
$1,402.58
|
| Rate for Payer: Networks By Design Commercial |
$935.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.58
|
|
|
TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION [224561]
|
Facility
OP
|
$1,122.06
|
|
|
Service Code
|
CPT J9356
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.02 |
| Max. Negotiated Rate |
$1,009.85 |
| Rate for Payer: Adventist Health Medi-Cal |
$66.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$409.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$82.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$72.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$72.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.84
|
| Rate for Payer: BCBS Transplant Transplant |
$673.24
|
| Rate for Payer: Blue Shield of California Commercial |
$102.85
|
| Rate for Payer: Blue Shield of California EPN |
$93.50
|
| Rate for Payer: Caremore Medicare Advantage |
$66.02
|
| Rate for Payer: Cash Price |
$504.93
|
| Rate for Payer: Cash Price |
$504.93
|
| Rate for Payer: Central Health Plan Commercial |
$897.65
|
| Rate for Payer: Cigna of CA HMO |
$785.44
|
| Rate for Payer: Cigna of CA PPO |
$785.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.13
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$66.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.02
|
| Rate for Payer: Galaxy Health WC |
$953.75
|
| Rate for Payer: Global Benefits Group Commercial |
$673.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,009.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$841.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$108.28
|
| Rate for Payer: IEHP medi-cal |
$108.94
|
| Rate for Payer: IEHP Medicare Advantage |
$66.02
|
| Rate for Payer: Innovage PACE Commercial |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.47
|
| Rate for Payer: Multiplan Commercial |
$841.54
|
| Rate for Payer: Networks By Design Commercial |
$561.03
|
| Rate for Payer: Prime Health Services Commercial |
$953.75
|
| Rate for Payer: Prime Health Services Medicare |
$69.98
|
| Rate for Payer: Riverside University Health MISP |
$72.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$561.03
|
| Rate for Payer: United Healthcare All Other HMO |
$561.03
|
| Rate for Payer: United Healthcare HMO Rider |
$561.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$561.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.62
|
| Rate for Payer: Vantage Medical Group Senior |
$72.62
|
|
|
TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION [224561]
|
Facility
IP
|
$1,122.06
|
|
|
Service Code
|
CPT J9356
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$224.41 |
| Max. Negotiated Rate |
$1,009.85 |
| Rate for Payer: Blue Shield of California Commercial |
$841.54
|
| Rate for Payer: Blue Shield of California EPN |
$599.18
|
| Rate for Payer: Cash Price |
$504.93
|
| Rate for Payer: Central Health Plan Commercial |
$897.65
|
| Rate for Payer: Cigna of CA HMO |
$785.44
|
| Rate for Payer: Cigna of CA PPO |
$785.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$448.82
|
| Rate for Payer: Galaxy Health WC |
$953.75
|
| Rate for Payer: Global Benefits Group Commercial |
$673.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,009.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.41
|
| Rate for Payer: Multiplan Commercial |
$841.54
|
| Rate for Payer: Networks By Design Commercial |
$561.03
|
| Rate for Payer: Prime Health Services Commercial |
$953.75
|
|
|
TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION [226189]
|
Facility
IP
|
$1,632.08
|
|
|
Service Code
|
NDC 55513-141-01
|
| Hospital Charge Code |
ERX226189
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$326.42 |
| Max. Negotiated Rate |
$1,468.87 |
| Rate for Payer: Blue Shield of California Commercial |
$1,224.06
|
| Rate for Payer: Blue Shield of California EPN |
$871.53
|
| Rate for Payer: Cash Price |
$734.44
|
| Rate for Payer: Central Health Plan Commercial |
$1,305.66
|
| Rate for Payer: Cigna of CA HMO |
$1,142.46
|
| Rate for Payer: Cigna of CA PPO |
$1,142.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$652.83
|
| Rate for Payer: Galaxy Health WC |
$1,387.27
|
| Rate for Payer: Global Benefits Group Commercial |
$979.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,468.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,088.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.42
|
| Rate for Payer: Multiplan Commercial |
$1,224.06
|
| Rate for Payer: Networks By Design Commercial |
$816.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.27
|
|
|
TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION [226189]
|
Facility
OP
|
$1,632.08
|
|
|
Service Code
|
NDC 55513-141-01
|
| Hospital Charge Code |
ERX226189
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$326.42 |
| Max. Negotiated Rate |
$1,468.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$991.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,387.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$897.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$897.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$790.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$964.23
|
| Rate for Payer: BCBS Transplant Transplant |
$979.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,026.58
|
| Rate for Payer: Blue Shield of California EPN |
$798.09
|
| Rate for Payer: Cash Price |
$734.44
|
| Rate for Payer: Cash Price |
$734.44
|
| Rate for Payer: Central Health Plan Commercial |
$1,305.66
|
| Rate for Payer: Cigna of CA HMO |
$1,142.46
|
| Rate for Payer: Cigna of CA PPO |
$1,142.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,387.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$652.83
|
| Rate for Payer: Galaxy Health WC |
$1,387.27
|
| Rate for Payer: Global Benefits Group Commercial |
$979.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,468.87
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,224.06
|
| Rate for Payer: IEHP medi-cal |
$571.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,088.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.42
|
| Rate for Payer: Multiplan Commercial |
$1,224.06
|
| Rate for Payer: Networks By Design Commercial |
$816.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.27
|
| Rate for Payer: Riverside University Health MISP |
$652.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$979.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$816.04
|
| Rate for Payer: United Healthcare All Other HMO |
$816.04
|
| Rate for Payer: United Healthcare HMO Rider |
$816.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$816.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,387.27
|
| Rate for Payer: Vantage Medical Group Senior |
$1,387.27
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION [225307]
|
Facility
OP
|
$4,569.82
|
|
|
Service Code
|
CPT Q5117
|
| Hospital Charge Code |
ERX225307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$4,112.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$174.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.77
|
| Rate for Payer: BCBS Transplant Transplant |
$2,741.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2,874.42
|
| Rate for Payer: Blue Shield of California EPN |
$2,234.64
|
| Rate for Payer: Caremore Medicare Advantage |
$17.64
|
| Rate for Payer: Cash Price |
$2,056.42
|
| Rate for Payer: Cash Price |
$2,056.42
|
| Rate for Payer: Central Health Plan Commercial |
$3,655.86
|
| Rate for Payer: Cigna of CA HMO |
$3,198.87
|
| Rate for Payer: Cigna of CA PPO |
$3,198.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.64
|
| Rate for Payer: Galaxy Health WC |
$3,884.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,741.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,112.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,427.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.93
|
| Rate for Payer: IEHP medi-cal |
$29.11
|
| Rate for Payer: IEHP Medicare Advantage |
$17.64
|
| Rate for Payer: Innovage PACE Commercial |
$26.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,048.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.64
|
| Rate for Payer: Multiplan Commercial |
$3,427.36
|
| Rate for Payer: Networks By Design Commercial |
$2,284.91
|
| Rate for Payer: Prime Health Services Commercial |
$3,884.35
|
| Rate for Payer: Prime Health Services Medicare |
$18.70
|
| Rate for Payer: Riverside University Health MISP |
$19.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,741.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,741.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,284.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,284.91
|
| Rate for Payer: United Healthcare HMO Rider |
$2,284.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,284.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.40
|
| Rate for Payer: Vantage Medical Group Senior |
$19.40
|
|
