|
Excision, tumor, soft tissue of shoulder area, subcutaneous; 3 cm or greater
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 23071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$130.87 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$2,025.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| 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 |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5 cm or greater
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 23073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,080.15 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,550.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| 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 |
$3,550.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,857.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: InnovAge PACE Commercial |
$5,325.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,080.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,757.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Prime Health Services Medicare |
$3,763.28
|
| Rate for Payer: Riverside University Health System MISP |
$3,905.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); less than 5 cm
|
Facility
|
OP
|
$7,027.00
|
|
|
Service Code
|
CPT 23076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$928.78 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,550.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| 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 |
$3,550.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,857.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: InnovAge PACE Commercial |
$5,325.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$928.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,757.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Prime Health Services Medicare |
$3,763.28
|
| Rate for Payer: Riverside University Health System MISP |
$3,905.29
|
| 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 |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm
|
Facility
|
OP
|
$7,027.00
|
|
|
Service Code
|
CPT 24075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$2,025.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| 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 |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); 1.5 cm or greater
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 26113
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$858.74 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$2,025.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| 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 |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); less than 1.5 cm
|
Facility
|
OP
|
$7,084.00
|
|
|
Service Code
|
CPT 26116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$545.38 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$545.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| 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 |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
IP
|
$46.05
|
|
|
Service Code
|
NDC 0009-7663-04
|
| Hospital Charge Code |
1711985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$41.44 |
| Rate for Payer: Blue Shield of California Commercial |
$34.54
|
| Rate for Payer: Blue Shield of California EPN |
$24.59
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Central Health Plan Commercial |
$36.84
|
| Rate for Payer: Cigna of CA HMO |
$32.24
|
| Rate for Payer: Cigna of CA PPO |
$32.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.42
|
| Rate for Payer: Galaxy Health WC |
$39.14
|
| Rate for Payer: Global Benefits Group Commercial |
$27.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$34.54
|
| Rate for Payer: Networks By Design Commercial |
$29.93
|
| Rate for Payer: Prime Health Services Commercial |
$39.14
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
IP
|
$13.03
|
|
|
Service Code
|
NDC 0054-0080-13
|
| Hospital Charge Code |
1711985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.73 |
| Rate for Payer: Blue Shield of California Commercial |
$9.77
|
| Rate for Payer: Blue Shield of California EPN |
$6.96
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Central Health Plan Commercial |
$10.42
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.77
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
OP
|
$13.03
|
|
|
Service Code
|
NDC 0054-0080-13
|
| Hospital Charge Code |
1711985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.70
|
| Rate for Payer: Blue Distinction Transplant |
$7.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8.20
|
| Rate for Payer: Blue Shield of California EPN |
$6.37
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Central Health Plan Commercial |
$10.42
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Media |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.77
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Riverside University Health System MISP |
$5.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
OP
|
$46.05
|
|
|
Service Code
|
NDC 0009-7663-04
|
| Hospital Charge Code |
1711985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$41.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.21
|
| Rate for Payer: Blue Distinction Transplant |
$27.63
|
| Rate for Payer: Blue Shield of California Commercial |
$28.97
|
| Rate for Payer: Blue Shield of California EPN |
$22.52
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Central Health Plan Commercial |
$36.84
|
| Rate for Payer: Cigna of CA HMO |
$32.24
|
| Rate for Payer: Cigna of CA PPO |
$32.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.14
|
| Rate for Payer: Dignity Health Media |
$39.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.42
|
| Rate for Payer: Galaxy Health WC |
$39.14
|
| Rate for Payer: Global Benefits Group Commercial |
$27.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$34.54
|
| Rate for Payer: Networks By Design Commercial |
$29.93
|
| Rate for Payer: Prime Health Services Commercial |
$39.14
|
| Rate for Payer: Riverside University Health System MISP |
$18.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.02
|
| Rate for Payer: United Healthcare All Other HMO |
$23.02
|
| Rate for Payer: United Healthcare HMO Rider |
$23.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.14
|
| Rate for Payer: Vantage Medical Group Senior |
$39.14
|
|
|
Exploration for postoperative hemorrhage, thrombosis or infection; neck
|
Facility
|
OP
|
$27,445.00
|
|
|
Service Code
|
CPT 35800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$754.05 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| 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 |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$97,866.62
|
|
|
Service Code
|
APR-DRG 9114
|
| Min. Negotiated Rate |
$61,810.50 |
| Max. Negotiated Rate |
$97,866.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$61,810.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73,657.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97,866.62
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$46,056.76
|
|
|
Service Code
|
APR-DRG 9113
|
| Min. Negotiated Rate |
$29,088.48 |
| Max. Negotiated Rate |
$46,056.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$29,088.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34,663.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46,056.76
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$33,809.25
|
|
|
Service Code
|
APR-DRG 9112
|
| Min. Negotiated Rate |
$21,353.21 |
| Max. Negotiated Rate |
$33,809.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,353.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,445.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,809.25
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$24,957.91
|
|
|
Service Code
|
APR-DRG 9111
|
| Min. Negotiated Rate |
$15,762.89 |
| Max. Negotiated Rate |
$24,957.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,762.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,784.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,957.91
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$27,282.92
|
|
|
Service Code
|
APR-DRG 7922
|
| Min. Negotiated Rate |
$17,231.32 |
| Max. Negotiated Rate |
$27,282.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,231.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,533.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,282.92
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$21,570.59
|
|
|
Service Code
|
APR-DRG 7921
|
| Min. Negotiated Rate |
$13,623.53 |
| Max. Negotiated Rate |
$21,570.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,623.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,234.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,570.59
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$40,651.24
|
|
|
Service Code
|
APR-DRG 7923
|
| Min. Negotiated Rate |
$25,674.47 |
| Max. Negotiated Rate |
$40,651.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,674.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30,595.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40,651.24
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$76,308.45
|
|
|
Service Code
|
APR-DRG 7924
|
| Min. Negotiated Rate |
$48,194.81 |
| Max. Negotiated Rate |
$76,308.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$48,194.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57,432.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76,308.45
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$30,884.80
|
|
|
Service Code
|
APR-DRG 9502
|
| Min. Negotiated Rate |
$19,506.19 |
| Max. Negotiated Rate |
$30,884.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,506.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,244.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,884.80
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$22,721.57
|
|
|
Service Code
|
APR-DRG 9501
|
| Min. Negotiated Rate |
$14,350.46 |
| Max. Negotiated Rate |
$22,721.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,350.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,100.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,721.57
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$85,317.62
|
|
|
Service Code
|
APR-DRG 9504
|
| Min. Negotiated Rate |
$53,884.81 |
| Max. Negotiated Rate |
$85,317.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$53,884.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64,212.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85,317.62
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$46,762.59
|
|
|
Service Code
|
APR-DRG 9503
|
| Min. Negotiated Rate |
$29,534.27 |
| Max. Negotiated Rate |
$46,762.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$29,534.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35,195.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46,762.59
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$11,130.24
|
|
|
Service Code
|
APR-DRG 8432
|
| Min. Negotiated Rate |
$7,029.62 |
| Max. Negotiated Rate |
$11,130.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,029.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,376.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,130.24
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$7,251.67
|
|
|
Service Code
|
APR-DRG 8431
|
| Min. Negotiated Rate |
$4,580.00 |
| Max. Negotiated Rate |
$7,251.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,580.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,457.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,251.67
|
|
