|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE [88317]
|
Facility
IP
|
$177.84
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
1740332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.57 |
| 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 |
$133.38
|
| Rate for Payer: Blue Shield of California EPN |
$94.97
|
| Rate for Payer: Cash Price |
$80.03
|
| Rate for Payer: Cash Price |
$80.03
|
| Rate for Payer: Central Health Plan Commercial |
$142.27
|
| Rate for Payer: Cigna of CA HMO |
$124.49
|
| Rate for Payer: Cigna of CA PPO |
$124.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.14
|
| Rate for Payer: Galaxy Health WC |
$151.16
|
| Rate for Payer: Global Benefits Group Commercial |
$106.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.57
|
| Rate for Payer: Multiplan Commercial |
$133.38
|
| Rate for Payer: Networks By Design Commercial |
$88.92
|
| Rate for Payer: Prime Health Services Commercial |
$151.16
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
OP
|
$113.05
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
NDG2224
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$101.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$63.15
|
| Rate for Payer: BCBS Transplant Transplant |
$67.83
|
| Rate for Payer: Blue Shield of California Commercial |
$69.86
|
| Rate for Payer: Blue Shield of California EPN |
$54.94
|
| Rate for Payer: Caremore Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$50.87
|
| Rate for Payer: Cash Price |
$50.87
|
| Rate for Payer: Central Health Plan Commercial |
$90.44
|
| Rate for Payer: Cigna of CA HMO |
$72.35
|
| Rate for Payer: Cigna of CA PPO |
$83.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$96.09
|
| Rate for Payer: Global Benefits Group Commercial |
$67.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$84.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: IEHP medi-cal |
$61.38
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Innovage PACE Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$84.79
|
| Rate for Payer: Networks By Design Commercial |
$73.48
|
| Rate for Payer: Prime Health Services Commercial |
$96.09
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$67.83
|
| Rate for Payer: Riverside University Health MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.83
|
| 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 HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| 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 Senior |
$37.20
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
IP
|
$92.05
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
NDG8259
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Central Health Plan Commercial |
$73.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.82
|
| Rate for Payer: Galaxy Health WC |
$78.24
|
| Rate for Payer: Global Benefits Group Commercial |
$55.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$69.04
|
| Rate for Payer: Networks By Design Commercial |
$59.83
|
| Rate for Payer: Prime Health Services Commercial |
$78.24
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
OP
|
$92.05
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
NDG8259
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$82.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$63.15
|
| Rate for Payer: BCBS Transplant Transplant |
$55.23
|
| Rate for Payer: Blue Shield of California Commercial |
$56.89
|
| Rate for Payer: Blue Shield of California EPN |
$44.74
|
| Rate for Payer: Caremore Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Central Health Plan Commercial |
$73.64
|
| Rate for Payer: Cigna of CA HMO |
$58.91
|
| Rate for Payer: Cigna of CA PPO |
$68.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$78.24
|
| Rate for Payer: Global Benefits Group Commercial |
$55.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$69.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: IEHP medi-cal |
$61.38
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Innovage PACE Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$69.04
|
| Rate for Payer: Networks By Design Commercial |
$59.83
|
| Rate for Payer: Prime Health Services Commercial |
$78.24
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$55.23
|
| Rate for Payer: Riverside University Health MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.23
|
| 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 HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| 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 Senior |
$37.20
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
IP
|
$113.05
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
NDG2224
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Cash Price |
$50.87
|
| Rate for Payer: Cash Price |
$50.87
|
| Rate for Payer: Central Health Plan Commercial |
$90.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.22
|
| Rate for Payer: Galaxy Health WC |
$96.09
|
| Rate for Payer: Global Benefits Group Commercial |
$67.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$84.79
|
| Rate for Payer: Networks By Design Commercial |
$73.48
|
| Rate for Payer: Prime Health Services Commercial |
$96.09
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
OP
|
$118.70
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
1720235
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$106.83 |
| Rate for Payer: Blue Shield of California EPN |
$57.69
|
| Rate for Payer: Caremore Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$63.15
|
| Rate for Payer: BCBS Transplant Transplant |
$71.22
|
| Rate for Payer: Blue Shield of California Commercial |
$73.36
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Central Health Plan Commercial |
$94.96
|
| Rate for Payer: Cigna of CA HMO |
$75.97
|
| Rate for Payer: Cigna of CA PPO |
$87.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$100.90
|
| Rate for Payer: Global Benefits Group Commercial |
$71.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$89.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: IEHP medi-cal |
$61.38
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Innovage PACE Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Networks By Design Commercial |
$77.16
|
| Rate for Payer: Prime Health Services Commercial |
$100.90
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$71.22
|
| Rate for Payer: Riverside University Health MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.22
|
| 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 HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| 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 Senior |
$37.20
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
IP
|
$118.70
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
1720235
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Central Health Plan Commercial |
$94.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.48
|
| Rate for Payer: Galaxy Health WC |
$100.90
|
| Rate for Payer: Global Benefits Group Commercial |
$71.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.74
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Networks By Design Commercial |
$77.16
|
| Rate for Payer: Prime Health Services Commercial |
$100.90
|
|
|
TUCATINIB 150 MG TABLET [227737]
|
Facility
OP
|
$235.14
|
|
|
Service Code
|
NDC 51144-002-12
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$211.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$142.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$199.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$129.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$129.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.92
|
| Rate for Payer: BCBS Transplant Transplant |
$141.08
|
| Rate for Payer: Blue Shield of California Commercial |
$147.90
|
| Rate for Payer: Blue Shield of California EPN |
$114.98
|
| Rate for Payer: Cash Price |
$105.81
|
| Rate for Payer: Central Health Plan Commercial |
$188.11
|
| Rate for Payer: Cigna of CA HMO |
$164.60
|
| Rate for Payer: Cigna of CA PPO |
$164.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$94.06
|
| Rate for Payer: Galaxy Health WC |
$199.87
|
| Rate for Payer: Global Benefits Group Commercial |
$141.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$176.36
|
| Rate for Payer: IEHP medi-cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Multiplan Commercial |
$176.36
|
| Rate for Payer: Networks By Design Commercial |
$152.84
|
| Rate for Payer: Prime Health Services Commercial |
$199.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$141.08
|
| Rate for Payer: Riverside University Health MISP |
$94.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.57
|
| Rate for Payer: United Healthcare All Other HMO |
$117.57
|
| Rate for Payer: United Healthcare HMO Rider |
$117.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.87
|
| Rate for Payer: Vantage Medical Group Senior |
$199.87
|
|
|
TUCATINIB 150 MG TABLET [227737]
|
Facility
IP
|
$235.14
|
|
|
Service Code
|
NDC 51144-002-12
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.03 |
| 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 |
$176.36
|
| Rate for Payer: Blue Shield of California EPN |
$125.56
|
| Rate for Payer: Cash Price |
$105.81
|
| Rate for Payer: Cash Price |
$105.81
|
| Rate for Payer: Central Health Plan Commercial |
$188.11
|
| Rate for Payer: Cigna of CA HMO |
$164.60
|
| Rate for Payer: Cigna of CA PPO |
$164.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.06
|
| Rate for Payer: Galaxy Health WC |
$199.87
|
| Rate for Payer: Global Benefits Group Commercial |
$141.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Multiplan Commercial |
$176.36
|
| Rate for Payer: Networks By Design Commercial |
$152.84
|
| Rate for Payer: Prime Health Services Commercial |
$199.87
|
|
|
TUCATINIB 50 MG TABLET [227736]
|
Facility
OP
|
$116.94
|
|
|
Service Code
|
NDC 51144-001-60
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$99.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.09
|
| Rate for Payer: BCBS Transplant Transplant |
$70.16
|
| Rate for Payer: Blue Shield of California Commercial |
$73.56
|
| Rate for Payer: Blue Shield of California EPN |
$57.18
|
| Rate for Payer: Cash Price |
$52.62
|
| Rate for Payer: Central Health Plan Commercial |
$93.55
|
| Rate for Payer: Cigna of CA HMO |
$81.86
|
| Rate for Payer: Cigna of CA PPO |
$81.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.78
|
| Rate for Payer: Galaxy Health WC |
$99.40
|
| Rate for Payer: Global Benefits Group Commercial |
$70.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$87.70
|
| Rate for Payer: IEHP medi-cal |
$40.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.39
|
| Rate for Payer: Multiplan Commercial |
$87.70
|
| Rate for Payer: Networks By Design Commercial |
$76.01
|
| Rate for Payer: Prime Health Services Commercial |
$99.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$70.16
|
| Rate for Payer: Riverside University Health MISP |
$46.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.47
|
| Rate for Payer: United Healthcare All Other HMO |
$58.47
|
| Rate for Payer: United Healthcare HMO Rider |
$58.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.40
|
| Rate for Payer: Vantage Medical Group Senior |
$99.40
|
|
|
TUCATINIB 50 MG TABLET [227736]
|
Facility
IP
|
$116.94
|
|
|
Service Code
|
NDC 51144-001-60
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.39 |
| 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 |
$87.70
|
| Rate for Payer: Blue Shield of California EPN |
$62.45
|
| Rate for Payer: Cash Price |
$52.62
|
| Rate for Payer: Cash Price |
$52.62
|
| Rate for Payer: Central Health Plan Commercial |
$93.55
|
| Rate for Payer: Cigna of CA HMO |
$81.86
|
| Rate for Payer: Cigna of CA PPO |
$81.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.78
|
| Rate for Payer: Galaxy Health WC |
$99.40
|
| Rate for Payer: Global Benefits Group Commercial |
$70.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.39
|
| Rate for Payer: Multiplan Commercial |
$87.70
|
| Rate for Payer: Networks By Design Commercial |
$76.01
|
| Rate for Payer: Prime Health Services Commercial |
$99.40
|
|
|
Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 69610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,905.44 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,905.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: IEHP medi-cal |
$3,143.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Innovage PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health MISP |
$2,095.98
|
| 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 |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
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
|
$25,512.00
|
|
|
Service Code
|
CPT 69637
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,603.71 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| 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 |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69646
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,603.71 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| 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 |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,603.71 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| 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 |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,603.71 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| 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 |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,603.71 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| 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 |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,603.71 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| 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 |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| 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 |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (eg, postfenestration)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| 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 |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69631
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| 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 |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Tympanostomy (requiring insertion of ventilating tube), general anesthesia
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 69436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,905.44 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,905.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: IEHP medi-cal |
$3,143.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Innovage PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health MISP |
$2,095.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML INTRAMUSCULAR SYRINGE [14678]
|
Facility
OP
|
$293.26
|
|
|
Service Code
|
CPT 90691
|
| Hospital Charge Code |
NDG14678
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$763.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$763.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$249.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$161.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$161.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.84
|
| Rate for Payer: BCBS Transplant Transplant |
$175.96
|
| Rate for Payer: Blue Shield of California Commercial |
$95.95
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$131.97
|
| Rate for Payer: Cash Price |
$131.97
|
| Rate for Payer: Central Health Plan Commercial |
$234.61
|
| Rate for Payer: Cigna of CA HMO |
$205.28
|
| Rate for Payer: Cigna of CA PPO |
$205.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$117.30
|
| Rate for Payer: Galaxy Health WC |
$249.27
|
| Rate for Payer: Global Benefits Group Commercial |
$175.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$263.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$219.94
|
| Rate for Payer: IEHP medi-cal |
$102.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$195.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.65
|
| Rate for Payer: Multiplan Commercial |
$219.94
|
| Rate for Payer: Networks By Design Commercial |
$146.63
|
| Rate for Payer: Prime Health Services Commercial |
$249.27
|
| Rate for Payer: Riverside University Health MISP |
$117.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.63
|
| Rate for Payer: United Healthcare All Other HMO |
$146.63
|
| Rate for Payer: United Healthcare HMO Rider |
$146.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.27
|
| Rate for Payer: Vantage Medical Group Senior |
$249.27
|
|
|
TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML INTRAMUSCULAR SYRINGE [14678]
|
Facility
IP
|
$293.26
|
|
|
Service Code
|
CPT 90691
|
| Hospital Charge Code |
NDG14678
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.65 |
| 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 |
$219.94
|
| Rate for Payer: Blue Shield of California EPN |
$156.60
|
| Rate for Payer: Cash Price |
$131.97
|
| Rate for Payer: Cash Price |
$131.97
|
| Rate for Payer: Central Health Plan Commercial |
$234.61
|
| Rate for Payer: Cigna of CA HMO |
$205.28
|
| Rate for Payer: Cigna of CA PPO |
$205.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$117.30
|
| Rate for Payer: Galaxy Health WC |
$249.27
|
| Rate for Payer: Global Benefits Group Commercial |
$175.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$263.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$195.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.65
|
| Rate for Payer: Multiplan Commercial |
$219.94
|
| Rate for Payer: Networks By Design Commercial |
$146.63
|
| Rate for Payer: Prime Health Services Commercial |
$249.27
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 363
|
| 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
|
|
