|
Amputation, metacarpal, with finger or thumb (ray amputation), single, with or without interosseous transfer
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 26910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 3051
|
| Min. Negotiated Rate |
$10,433.54 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,433.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$12,433.31
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 3052
|
| Min. Negotiated Rate |
$13,911.40 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,911.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$16,577.75
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
IP
|
$46,613.90
|
|
|
Service Code
|
APR-DRG 3054
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$46,613.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$39,116.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$46,613.90
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 3053
|
| Min. Negotiated Rate |
$21,070.94 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,070.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$25,109.54
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 617
|
| 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
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 616
|
| 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
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 618
|
| 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
|
|
|
Amputation, toe; interphalangeal joint
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 28825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Amputation, toe; metatarsophalangeal joint
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| 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 |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 0172-5241-60
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| 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 |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 0172-5241-60
|
| Hospital Charge Code |
1711743
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
OP
|
$329.59
|
|
|
Service Code
|
CPT J3590
|
| Hospital Charge Code |
1712540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.92 |
| Max. Negotiated Rate |
$296.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$200.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$280.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$181.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$181.27
|
| Rate for Payer: BCBS Transplant Transplant |
$197.75
|
| Rate for Payer: Blue Shield of California Commercial |
$207.31
|
| Rate for Payer: Blue Shield of California EPN |
$161.17
|
| Rate for Payer: Cash Price |
$148.32
|
| Rate for Payer: Cash Price |
$148.32
|
| Rate for Payer: Central Health Plan Commercial |
$263.67
|
| Rate for Payer: Cigna of CA HMO |
$230.71
|
| Rate for Payer: Cigna of CA PPO |
$230.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$131.84
|
| Rate for Payer: Galaxy Health WC |
$280.15
|
| Rate for Payer: Global Benefits Group Commercial |
$197.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$296.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$247.19
|
| Rate for Payer: IEHP medi-cal |
$115.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.92
|
| Rate for Payer: Multiplan Commercial |
$247.19
|
| Rate for Payer: Networks By Design Commercial |
$164.80
|
| Rate for Payer: Prime Health Services Commercial |
$280.15
|
| Rate for Payer: Riverside University Health MISP |
$131.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$197.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$197.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.80
|
| Rate for Payer: United Healthcare All Other HMO |
$164.80
|
| Rate for Payer: United Healthcare HMO Rider |
$164.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.15
|
| Rate for Payer: Vantage Medical Group Senior |
$280.15
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
IP
|
$329.59
|
|
|
Service Code
|
CPT J3590
|
| Hospital Charge Code |
1712540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.92 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Cigna of CA PPO |
$230.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$247.19
|
| Rate for Payer: Blue Shield of California EPN |
$176.00
|
| Rate for Payer: Cash Price |
$148.32
|
| Rate for Payer: Cash Price |
$148.32
|
| Rate for Payer: Central Health Plan Commercial |
$263.67
|
| Rate for Payer: Cigna of CA HMO |
$230.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$131.84
|
| Rate for Payer: Galaxy Health WC |
$280.15
|
| Rate for Payer: Global Benefits Group Commercial |
$197.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$296.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.92
|
| Rate for Payer: Multiplan Commercial |
$247.19
|
| Rate for Payer: Networks By Design Commercial |
$164.80
|
| Rate for Payer: Prime Health Services Commercial |
$280.15
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2261
|
| Min. Negotiated Rate |
$8,257.22 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,257.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$9,839.86
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2263
|
| Min. Negotiated Rate |
$16,030.58 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,030.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$19,103.11
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2262
|
| Min. Negotiated Rate |
$10,926.38 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,926.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$13,020.61
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2264
|
| Min. Negotiated Rate |
$26,796.79 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,796.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$31,932.84
|
|
|
ANAL AND STOMAL PROCEDURES WITH CC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 348
|
| 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
|
|
|
ANAL AND STOMAL PROCEDURES WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 347
|
| 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
|
|
|
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 349
|
| 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
|
|
|
Anastomosis; facial-hypoglossal
|
Facility
OP
|
$7,830.00
|
|
|
Service Code
|
CPT 64868
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$7,830.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,566.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: 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
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
IP
|
$1.09
|
|
|
Service Code
|
CPT S0170
|
| Hospital Charge Code |
1711729
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
