|
FOSPHENYTOIN 50 MG PE/ML IV INJECTION SOLUTION WRAP [408056880]
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
CPT Q2009
|
| Hospital Charge Code |
1720991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$6.75
|
| Rate for Payer: Blue Shield of California Commercial |
$17.32
|
| Rate for Payer: Blue Shield of California EPN |
$12.34
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$18.48
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA HMO |
$16.17
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$16.17
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$19.64
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Galaxy Health WC |
$2.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Global Benefits Group Commercial |
$13.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$17.32
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$11.55
|
| Rate for Payer: Networks By Design Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Prime Health Services Commercial |
$19.64
|
| Rate for Payer: Prime Health Services Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$8.52
|
| Rate for Payer: United Healthcare All Other HMO |
$3.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1.04
|
| Rate for Payer: United Healthcare HMO Rider |
$3.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
|
|
FOSPHENYTOIN 50 MG PE/ML IV INJECTION SOLUTION WRAP [408056880]
|
Facility
|
OP
|
$13.86
|
|
|
Service Code
|
CPT Q2009
|
| Hospital Charge Code |
1720986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.82
|
| Rate for Payer: Blue Distinction Transplant |
$8.32
|
| Rate for Payer: Blue Shield of California Commercial |
$6.13
|
| Rate for Payer: Blue Shield of California EPN |
$5.57
|
| Rate for Payer: Caremore Medicare Advantage |
$4.80
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Central Health Plan Commercial |
$11.09
|
| Rate for Payer: Cigna of CA HMO |
$9.70
|
| Rate for Payer: Cigna of CA PPO |
$9.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.20
|
| Rate for Payer: Dignity Health Media |
$4.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$11.78
|
| Rate for Payer: Global Benefits Group Commercial |
$8.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.80
|
| Rate for Payer: InnovAge PACE Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$11.78
|
| Rate for Payer: Prime Health Services Medicare |
$5.09
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.93
|
| Rate for Payer: United Healthcare All Other HMO |
$6.93
|
| Rate for Payer: United Healthcare HMO Rider |
$6.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.80
|
|
|
Fracture nasal inferior turbinate(s), therapeutic
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 30930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| 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 |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,637.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| 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 |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$13,034.93
|
|
|
Service Code
|
APR-DRG 3403
|
| Min. Negotiated Rate |
$8,232.59 |
| Max. Negotiated Rate |
$13,034.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,232.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,810.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,034.93
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$9,142.19
|
|
|
Service Code
|
APR-DRG 3402
|
| Min. Negotiated Rate |
$5,774.02 |
| Max. Negotiated Rate |
$9,142.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,774.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,880.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,142.19
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$19,174.65
|
|
|
Service Code
|
APR-DRG 3404
|
| Min. Negotiated Rate |
$12,110.30 |
| Max. Negotiated Rate |
$19,174.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,110.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,431.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,174.65
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$7,354.54
|
|
|
Service Code
|
APR-DRG 3401
|
| Min. Negotiated Rate |
$4,644.97 |
| Max. Negotiated Rate |
$7,354.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,644.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,535.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,354.54
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$12,348.59
|
|
|
Service Code
|
APR-DRG 3413
|
| Min. Negotiated Rate |
$7,799.11 |
| Max. Negotiated Rate |
$12,348.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,799.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,293.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,348.59
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$9,691.96
|
|
|
Service Code
|
APR-DRG 3412
|
| Min. Negotiated Rate |
$6,121.24 |
| Max. Negotiated Rate |
$9,691.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,121.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,294.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,691.96
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$23,042.57
|
|
|
Service Code
|
APR-DRG 3414
|
| Min. Negotiated Rate |
$14,553.20 |
| Max. Negotiated Rate |
$23,042.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,553.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,342.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,042.57
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$7,902.54
|
|
|
Service Code
|
APR-DRG 3411
|
| Min. Negotiated Rate |
$4,991.08 |
| Max. Negotiated Rate |
$7,902.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,991.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,947.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,902.54
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$24,436.51
|
|
|
Service Code
|
APR-DRG 3424
|
| Min. Negotiated Rate |
$15,433.58 |
| Max. Negotiated Rate |
$24,436.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,433.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,391.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,436.51
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$7,925.58
|
|
|
Service Code
|
APR-DRG 3421
|
| Min. Negotiated Rate |
$5,005.63 |
| Max. Negotiated Rate |
$7,925.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,005.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,965.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,925.58
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$14,877.55
|
|
|
Service Code
|
APR-DRG 3423
|
| Min. Negotiated Rate |
$9,396.35 |
| Max. Negotiated Rate |
$14,877.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,396.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,197.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,877.55
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$10,674.45
|
|
|
Service Code
|
APR-DRG 3422
|
| Min. Negotiated Rate |
$6,741.76 |
| Max. Negotiated Rate |
$10,674.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,741.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,033.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,674.45
|
|
|
Frenoplasty (surgical revision of frenum, eg, with Z-plasty)
|
Facility
|
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 41520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$445.64 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| 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 |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,637.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| 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 |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
Frenulotomy of penis
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 54164
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$294.98 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| 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 |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,199.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| 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 |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less
|
Facility
|
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 15240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.04 |
| 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 |
$128.04
|
| 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
|
|
|
Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
|
Facility
|
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 15241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.95
|
| 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
|
|
|
Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less
|
Facility
|
OP
|
$7,027.00
|
|
|
Service Code
|
CPT 15260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 |
$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 |
$2,278.49
|
| 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 |
$160.57
|
| 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
|
|
|
Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less
|
Facility
|
OP
|
$7,027.00
|
|
|
Service Code
|
CPT 15220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 |
$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 |
$2,278.49
|
| 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 |
$111.76
|
| 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
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT J9394
|
| Hospital Charge Code |
1755723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Blue Shield of California Commercial |
$63.00
|
| Rate for Payer: Blue Shield of California Commercial |
$76.50
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.47
|
| Rate for Payer: Blue Shield of California EPN |
$64.08
|
| Rate for Payer: Blue Shield of California EPN |
$44.86
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$81.60
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$71.40
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$71.40
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.72
|
| Rate for Payer: United Healthcare All Other HMO |
$37.62
|
| Rate for Payer: United Healthcare All Other HMO |
$44.26
|
| Rate for Payer: United Healthcare All Other HMO |
$30.98
|
| Rate for Payer: United Healthcare HMO Rider |
$43.30
|
| Rate for Payer: United Healthcare HMO Rider |
$30.31
|
| Rate for Payer: United Healthcare HMO Rider |
$36.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.72
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT J9394
|
| Hospital Charge Code |
1755723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$328.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$53.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$53.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$53.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.29
|
| Rate for Payer: Blue Distinction Transplant |
$50.40
|
| Rate for Payer: Blue Distinction Transplant |
$61.20
|
| Rate for Payer: Blue Distinction Transplant |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$75.48
|
| Rate for Payer: Blue Shield of California Commercial |
$52.84
|
| Rate for Payer: Blue Shield of California Commercial |
$64.16
|
| Rate for Payer: Blue Shield of California EPN |
$49.88
|
| Rate for Payer: Blue Shield of California EPN |
$58.68
|
| Rate for Payer: Blue Shield of California EPN |
$41.08
|
| Rate for Payer: Caremore Medicare Advantage |
$53.00
|
| Rate for Payer: Caremore Medicare Advantage |
$53.00
|
| Rate for Payer: Caremore Medicare Advantage |
$53.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$81.60
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA HMO |
$71.40
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$71.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.50
|
| Rate for Payer: Dignity Health Media |
$53.00
|
| Rate for Payer: Dignity Health Media |
$53.00
|
| Rate for Payer: Dignity Health Media |
$53.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$53.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.00
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$76.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$90.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$86.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$86.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$86.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$53.00
|
| Rate for Payer: InnovAge PACE Commercial |
$79.50
|
| Rate for Payer: InnovAge PACE Commercial |
$79.50
|
| Rate for Payer: InnovAge PACE Commercial |
$79.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.02
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: Networks By Design Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
| Rate for Payer: Prime Health Services Medicare |
$56.18
|
| Rate for Payer: Prime Health Services Medicare |
$56.18
|
| Rate for Payer: Prime Health Services Medicare |
$56.18
|
| Rate for Payer: Riverside University Health System MISP |
$58.30
|
| Rate for Payer: Riverside University Health System MISP |
$58.30
|
| Rate for Payer: Riverside University Health System MISP |
$58.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$51.00
|
| Rate for Payer: United Healthcare HMO Rider |
$42.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Vantage Medical Group Senior |
$53.00
|
| Rate for Payer: Vantage Medical Group Senior |
$53.00
|
| Rate for Payer: Vantage Medical Group Senior |
$53.00
|
|
|
FUROSEMIDE 10 MG/ML CONTINUOUS INFUSION (UNDILUTED) [4083291]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
1720047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.25
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Media |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
FUROSEMIDE 10 MG/ML CONTINUOUS INFUSION (UNDILUTED) [4083291]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
1720047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
|
