|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC
|
Facility
|
IP
|
$26,535.63
|
|
|
Service Code
|
MSDRG 354
|
| Min. Negotiated Rate |
$19,802.71 |
| Max. Negotiated Rate |
$26,535.63 |
| Rate for Payer: EPIC Health Plan Medicare |
$19,802.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,802.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,773.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,535.63
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC
|
Facility
|
IP
|
$45,263.18
|
|
|
Service Code
|
MSDRG 353
|
| Min. Negotiated Rate |
$33,778.49 |
| Max. Negotiated Rate |
$45,263.18 |
| Rate for Payer: EPIC Health Plan Medicare |
$33,778.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,778.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,845.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,263.18
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC
|
Facility
|
IP
|
$21,354.70
|
|
|
Service Code
|
MSDRG 355
|
| Min. Negotiated Rate |
$15,936.34 |
| Max. Negotiated Rate |
$21,354.70 |
| Rate for Payer: EPIC Health Plan Medicare |
$15,936.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,936.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,326.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,354.70
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC
|
Facility
|
IP
|
$32,863.61
|
|
|
Service Code
|
MSDRG 481
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$32,863.61 |
| Rate for Payer: EPIC Health Plan Medicare |
$24,525.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,525.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,203.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,863.61
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC
|
Facility
|
IP
|
$45,421.34
|
|
|
Service Code
|
MSDRG 480
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$45,421.34 |
| Rate for Payer: EPIC Health Plan Medicare |
$33,896.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,896.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,981.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,421.34
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC
|
Facility
|
IP
|
$25,746.37
|
|
|
Service Code
|
MSDRG 482
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$25,746.37 |
| Rate for Payer: EPIC Health Plan Medicare |
$19,213.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,213.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,095.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,746.37
|
|
|
Hip Implant (must be billed with Hip Surgery ICD-10-PCS)
|
Facility
|
IP
|
$7,663.00
|
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,663.00 |
| Max. Negotiated Rate |
$7,663.00 |
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,663.00
|
|
|
Hip Implant (must be billed with Hip Surgery ICD-10-PCS)
|
Facility
|
IP
|
$7,663.00
|
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,663.00 |
| Max. Negotiated Rate |
$7,663.00 |
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,663.00
|
|
|
Hip Implant (must be billed with Hip Surgery ICD-10-PCS)
|
Facility
|
IP
|
$7,663.00
|
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,663.00 |
| Max. Negotiated Rate |
$7,663.00 |
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,663.00
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC
|
Facility
|
IP
|
$44,774.85
|
|
|
Service Code
|
MSDRG 521
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$44,774.85 |
| Rate for Payer: EPIC Health Plan Medicare |
$33,414.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,414.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,426.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44,774.85
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC
|
Facility
|
IP
|
$33,219.87
|
|
|
Service Code
|
MSDRG 522
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$33,219.87 |
| Rate for Payer: EPIC Health Plan Medicare |
$24,790.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,790.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,509.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,219.87
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$94,697.04
|
|
|
Service Code
|
MSDRG 969
|
| Min. Negotiated Rate |
$70,669.43 |
| Max. Negotiated Rate |
$94,697.04 |
| Rate for Payer: EPIC Health Plan Medicare |
$70,669.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70,669.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,269.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94,697.04
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$41,200.08
|
|
|
Service Code
|
MSDRG 970
|
| Min. Negotiated Rate |
$30,746.33 |
| Max. Negotiated Rate |
$41,200.08 |
| Rate for Payer: EPIC Health Plan Medicare |
$30,746.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,746.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,358.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41,200.08
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH CC
|
Facility
|
IP
|
$20,586.92
|
|
|
Service Code
|
MSDRG 975
|
| Min. Negotiated Rate |
$15,363.37 |
| Max. Negotiated Rate |
$20,586.92 |
| Rate for Payer: EPIC Health Plan Medicare |
$15,363.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,363.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,667.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,586.92
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH MCC
|
Facility
|
IP
|
$45,017.49
|
|
|
Service Code
|
MSDRG 974
|
| Min. Negotiated Rate |
$33,595.14 |
| Max. Negotiated Rate |
$45,017.49 |
| Rate for Payer: EPIC Health Plan Medicare |
$33,595.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,595.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,634.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,017.49
|
|
|
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC
|
Facility
|
IP
|
$14,562.97
|
|
|
Service Code
|
MSDRG 976
|
| Min. Negotiated Rate |
$10,867.89 |
| Max. Negotiated Rate |
$14,562.97 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,867.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,867.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,498.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,562.97
|
|
|
HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$20,628.40
|
|
|
Service Code
|
MSDRG 977
|
| Min. Negotiated Rate |
$15,394.33 |
| Max. Negotiated Rate |
$20,628.40 |
| Rate for Payer: EPIC Health Plan Medicare |
$15,394.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,394.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,703.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,628.40
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
|
OP
|
$788.02
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$669.82 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$487.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$669.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$433.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$591.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.91
|
| Rate for Payer: Blue Shield of California Commercial |
$313.63
|
| Rate for Payer: Blue Shield of California EPN |
$313.63
|
| Rate for Payer: Cash Price |
$354.61
|
| Rate for Payer: Cash Price |
$354.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$362.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$669.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$669.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$669.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$364.85
|
| Rate for Payer: Heritage Provider Network Senior |
$364.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$375.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$551.61
|
| Rate for Payer: Multiplan Commercial |
$591.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$315.21
|
| Rate for Payer: TriValley Medical Group Senior |
$315.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$284.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$260.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$669.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$669.82
|
| Rate for Payer: Vantage Medical Group Senior |
$669.82
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
|
IP
|
$788.02
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$591.01 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$507.48
|
| Rate for Payer: Cash Price |
$354.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$362.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$364.85
|
| Rate for Payer: Heritage Provider Network Senior |
$364.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.00
|
| Rate for Payer: Multiplan Commercial |
$591.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$284.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$260.91
|
|
|
HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.31
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION [239091]
|
Facility
|
OP
|
$3.78
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$7.70 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California EPN |
$3.21
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.51
|
| Rate for Payer: TriValley Medical Group Senior |
$1.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION [239091]
|
Facility
|
IP
|
$3.78
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.43
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.25
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
|
OP
|
$66.96
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Adventist Health Commercial |
$13.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.00
|
| Rate for Payer: Heritage Provider Network Senior |
$31.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.78
|
| Rate for Payer: TriValley Medical Group Senior |
$26.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.92
|
| Rate for Payer: Vantage Medical Group Senior |
$56.92
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
|
IP
|
$66.96
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$50.22 |
| Rate for Payer: Adventist Health Commercial |
$13.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.12
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.00
|
| Rate for Payer: Heritage Provider Network Senior |
$31.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.17
|
|
