|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 669
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 668
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 670
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 4822
|
| Min. Negotiated Rate |
$8,735.51 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,735.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$10,409.81
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 4821
|
| Min. Negotiated Rate |
$7,142.75 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,142.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$8,511.77
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 4823
|
| Min. Negotiated Rate |
$15,887.22 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,887.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$18,932.27
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 4824
|
| Min. Negotiated Rate |
$26,437.25 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,437.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$31,504.39
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 713
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 714
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
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 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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 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
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION [225307]
|
Facility
IP
|
$4,569.82
|
|
|
Service Code
|
CPT Q5117
|
| Hospital Charge Code |
ERX225307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$913.96 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3,427.36
|
| Rate for Payer: Blue Shield of California EPN |
$2,440.28
|
| 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: EPIC Health Plan Commercial |
$1,827.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,827.93
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,048.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.96
|
| 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
|
|
|
TRAUMATIC INJURY AGE 0-17
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 269
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
TRAUMATIC INJURY AGE >17 WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 913
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
TRAUMATIC INJURY AGE >17 WITHOUT MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 914
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR AGE 0-17
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 105
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR AGE >17 WITH CC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 086
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
