|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$17,686.72
|
|
|
Service Code
|
APR-DRG 0423
|
| Min. Negotiated Rate |
$11,170.56 |
| Max. Negotiated Rate |
$17,686.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,170.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,311.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,686.72
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$31,493.11
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$19,890.38 |
| Max. Negotiated Rate |
$31,493.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,890.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,702.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31,493.11
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$10,357.01
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$6,541.27 |
| Max. Negotiated Rate |
$10,357.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,541.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,795.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,357.01
|
|
|
Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips
|
Facility
|
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 15630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| 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 |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,759.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| 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 |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet
|
Facility
|
OP
|
$10,567.00
|
|
|
Service Code
|
CPT 15620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| 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 |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,759.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| 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 |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-01
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Blue Shield of California Commercial |
$6.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.44
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Central Health Plan Commercial |
$6.66
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-11
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Blue Shield of California Commercial |
$6.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.44
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Central Health Plan Commercial |
$6.66
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-11
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.92
|
| Rate for Payer: Blue Distinction Transplant |
$4.99
|
| Rate for Payer: Blue Shield of California Commercial |
$5.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.07
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Central Health Plan Commercial |
$6.66
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.07
|
| Rate for Payer: Dignity Health Media |
$7.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
| Rate for Payer: Riverside University Health System MISP |
$3.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare HMO Rider |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.07
|
| Rate for Payer: Vantage Medical Group Senior |
$7.07
|
|
|
DEMECLOCYCLINE 150 MG TABLET [9726]
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
NDC 62584-159-01
|
| Hospital Charge Code |
1711453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.92
|
| Rate for Payer: Blue Distinction Transplant |
$4.99
|
| Rate for Payer: Blue Shield of California Commercial |
$5.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.07
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Central Health Plan Commercial |
$6.66
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.07
|
| Rate for Payer: Dignity Health Media |
$7.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
| Rate for Payer: Riverside University Health System MISP |
$3.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare HMO Rider |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.07
|
| Rate for Payer: Vantage Medical Group Senior |
$7.07
|
|
|
DEMECLOCYCLINE 300 MG TABLET [9727]
|
Facility
|
IP
|
$15.13
|
|
|
Service Code
|
NDC 62584-163-11
|
| Hospital Charge Code |
1710010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Blue Shield of California Commercial |
$11.35
|
| Rate for Payer: Blue Shield of California EPN |
$8.08
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Central Health Plan Commercial |
$12.10
|
| Rate for Payer: Cigna of CA HMO |
$10.59
|
| Rate for Payer: Cigna of CA PPO |
$10.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: Galaxy Health WC |
$12.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$11.35
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$12.86
|
|
|
DEMECLOCYCLINE 300 MG TABLET [9727]
|
Facility
|
OP
|
$15.13
|
|
|
Service Code
|
NDC 62584-163-11
|
| Hospital Charge Code |
1710010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.94
|
| Rate for Payer: Blue Distinction Transplant |
$9.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$7.40
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Central Health Plan Commercial |
$12.10
|
| Rate for Payer: Cigna of CA HMO |
$10.59
|
| Rate for Payer: Cigna of CA PPO |
$10.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.86
|
| Rate for Payer: Dignity Health Media |
$12.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.05
|
| Rate for Payer: Galaxy Health WC |
$12.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$11.35
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$12.86
|
| Rate for Payer: Riverside University Health System MISP |
$6.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.56
|
| Rate for Payer: United Healthcare All Other HMO |
$7.56
|
| Rate for Payer: United Healthcare HMO Rider |
$7.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.86
|
| Rate for Payer: Vantage Medical Group Senior |
$12.86
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
|
IP
|
$2,109.35
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$421.87 |
| Max. Negotiated Rate |
$1,898.42 |
| Rate for Payer: Blue Shield of California Commercial |
$1,582.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,126.39
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Central Health Plan Commercial |
$1,687.48
|
| Rate for Payer: Cigna of CA HMO |
$1,476.54
|
| Rate for Payer: Cigna of CA PPO |
$1,476.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$843.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$843.74
|
| Rate for Payer: Galaxy Health WC |
$1,792.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,265.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,898.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,406.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$803.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.87
|
| Rate for Payer: Multiplan Commercial |
$1,582.01
|
| Rate for Payer: Networks By Design Commercial |
$1,054.68
|
| Rate for Payer: Prime Health Services Commercial |
$1,792.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.49
|
| Rate for Payer: United Healthcare All Other HMO |
$777.93
|
| Rate for Payer: United Healthcare HMO Rider |
$761.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$696.09
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
|
OP
|
$2,109.35
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$1,898.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.31
|
| Rate for Payer: Blue Distinction Transplant |
$1,265.61
|
| Rate for Payer: Blue Shield of California Commercial |
$27.01
|
| Rate for Payer: Blue Shield of California EPN |
$24.55
|
| Rate for Payer: Caremore Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Central Health Plan Commercial |
$1,687.48
|
| Rate for Payer: Cigna of CA HMO |
$1,476.54
|
| Rate for Payer: Cigna of CA PPO |
$1,476.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.80
|
| Rate for Payer: Dignity Health Media |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$1,792.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,265.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,898.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,582.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.20
|
| Rate for Payer: InnovAge PACE Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,406.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.77
|
| Rate for Payer: Multiplan Commercial |
$1,582.01
|
| Rate for Payer: Networks By Design Commercial |
$1,054.68
|
| Rate for Payer: Prime Health Services Commercial |
$1,792.95
|
| Rate for Payer: Prime Health Services Medicare |
$26.71
|
| Rate for Payer: Riverside University Health System MISP |
$27.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,265.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,265.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,054.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,054.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,054.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,054.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.20
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
|
IP
|
$1,949.45
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$389.89 |
| Max. Negotiated Rate |
$1,754.50 |
| Rate for Payer: Blue Shield of California Commercial |
$1,462.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,041.01
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,559.56
|
| Rate for Payer: Cigna of CA HMO |
$1,364.62
|
| Rate for Payer: Cigna of CA PPO |
$1,364.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$779.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$779.78
|
| Rate for Payer: Galaxy Health WC |
$1,657.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,754.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.89
|
| Rate for Payer: Multiplan Commercial |
$1,462.09
|
| Rate for Payer: Networks By Design Commercial |
$974.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$736.11
|
| Rate for Payer: United Healthcare All Other HMO |
$718.96
|
| Rate for Payer: United Healthcare HMO Rider |
$703.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.32
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
|
OP
|
$1,949.45
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$1,754.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.31
|
| Rate for Payer: Blue Distinction Transplant |
$1,169.67
|
| Rate for Payer: Blue Shield of California Commercial |
$27.01
|
| Rate for Payer: Blue Shield of California EPN |
$24.55
|
| Rate for Payer: Caremore Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,559.56
|
| Rate for Payer: Cigna of CA HMO |
$1,364.62
|
| Rate for Payer: Cigna of CA PPO |
$1,364.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.80
|
| Rate for Payer: Dignity Health Media |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$1,657.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,754.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,462.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.20
|
| Rate for Payer: InnovAge PACE Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.77
|
| Rate for Payer: Multiplan Commercial |
$1,462.09
|
| Rate for Payer: Networks By Design Commercial |
$974.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.03
|
| Rate for Payer: Prime Health Services Medicare |
$26.71
|
| Rate for Payer: Riverside University Health System MISP |
$27.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,169.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,169.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$974.72
|
| Rate for Payer: United Healthcare All Other HMO |
$974.72
|
| Rate for Payer: United Healthcare HMO Rider |
$974.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$974.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.20
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$8,439.90
|
|
|
Service Code
|
APR-DRG 1142
|
| Min. Negotiated Rate |
$5,330.46 |
| Max. Negotiated Rate |
$8,439.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,330.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,352.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,439.90
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$13,556.33
|
|
|
Service Code
|
APR-DRG 1143
|
| Min. Negotiated Rate |
$8,561.89 |
| Max. Negotiated Rate |
$13,556.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,561.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,202.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,556.33
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$6,114.88
|
|
|
Service Code
|
APR-DRG 1141
|
| Min. Negotiated Rate |
$3,862.03 |
| Max. Negotiated Rate |
$6,114.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,862.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,602.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,114.88
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$23,725.36
|
|
|
Service Code
|
APR-DRG 1144
|
| Min. Negotiated Rate |
$14,984.44 |
| Max. Negotiated Rate |
$23,725.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,984.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,856.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,725.36
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
|
IP
|
$22,792.51
|
|
|
Service Code
|
APR-DRG 7544
|
| Min. Negotiated Rate |
$14,395.27 |
| Max. Negotiated Rate |
$22,792.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,395.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,154.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,792.51
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
|
IP
|
$5,077.41
|
|
|
Service Code
|
APR-DRG 7541
|
| Min. Negotiated Rate |
$3,206.78 |
| Max. Negotiated Rate |
$5,077.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,206.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,821.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,077.41
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
|
IP
|
$10,777.31
|
|
|
Service Code
|
APR-DRG 7543
|
| Min. Negotiated Rate |
$6,806.72 |
| Max. Negotiated Rate |
$10,777.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,806.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,111.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,777.31
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
|
IP
|
$6,792.35
|
|
|
Service Code
|
APR-DRG 7542
|
| Min. Negotiated Rate |
$4,289.90 |
| Max. Negotiated Rate |
$6,792.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,289.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,112.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,792.35
|
|
|
Dermabrasion; segmental, face
|
Facility
|
OP
|
$4,846.00
|
|
|
Service Code
|
CPT 15781
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,241.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| 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: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Dermabrasion; superficial, any site (eg, tattoo removal)
|
Facility
|
OP
|
$4,846.00
|
|
|
Service Code
|
CPT 15783
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$286.48 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,950.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
