|
RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG, FOR STENOSIS DUE TO INJURY, INFECTION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$14,466.39
|
|
|
Service Code
|
CPT 69310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,245.00 |
| Max. Negotiated Rate |
$14,466.39 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,613.89
|
| Rate for Payer: Heritage Provider Network Senior |
$9,365.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,466.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,755.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,375.28
|
| Rate for Payer: TriValley Medical Group Senior |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$36,667.17
|
|
|
Service Code
|
MSDRG 333
|
| Min. Negotiated Rate |
$27,363.56 |
| Max. Negotiated Rate |
$36,667.17 |
| Rate for Payer: EPIC Health Plan Medicare |
$27,363.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,363.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,468.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36,667.17
|
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$56,299.14
|
|
|
Service Code
|
MSDRG 332
|
| Min. Negotiated Rate |
$42,014.28 |
| Max. Negotiated Rate |
$56,299.14 |
| Rate for Payer: EPIC Health Plan Medicare |
$42,014.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42,014.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48,316.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56,299.14
|
|
|
RECTAL RESECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$25,852.33
|
|
|
Service Code
|
MSDRG 334
|
| Min. Negotiated Rate |
$19,292.78 |
| Max. Negotiated Rate |
$25,852.33 |
| Rate for Payer: EPIC Health Plan Medicare |
$19,292.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,292.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,186.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,852.33
|
|
|
RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$22,265.25
|
|
|
Service Code
|
MSDRG 811
|
| Min. Negotiated Rate |
$16,615.86 |
| Max. Negotiated Rate |
$22,265.25 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,615.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,615.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,108.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,265.25
|
|
|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$14,800.98
|
|
|
Service Code
|
MSDRG 812
|
| Min. Negotiated Rate |
$11,045.51 |
| Max. Negotiated Rate |
$14,800.98 |
| Rate for Payer: EPIC Health Plan Medicare |
$11,045.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,045.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,702.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,800.98
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.90
|
| Rate for Payer: Blue Shield of California Commercial |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$7.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.65
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Senior |
$1.92
|
| Rate for Payer: TriValley Medical Group Senior |
$2.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.64
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.59
|
|
|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$24,481.08
|
|
|
Service Code
|
MSDRG 945
|
| Min. Negotiated Rate |
$18,269.46 |
| Max. Negotiated Rate |
$24,481.08 |
| Rate for Payer: EPIC Health Plan Medicare |
$18,269.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,269.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,009.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24,481.08
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$18,311.25
|
|
|
Service Code
|
MSDRG 946
|
| Min. Negotiated Rate |
$13,665.11 |
| Max. Negotiated Rate |
$18,311.25 |
| Rate for Payer: EPIC Health Plan Medicare |
$13,665.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,665.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,714.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,311.25
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
IP
|
$113.81
|
|
|
Service Code
|
NDC 7297412001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: Adventist Health Commercial |
$22.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.29
|
| Rate for Payer: Cash Price |
$51.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.05
|
| Rate for Payer: Heritage Provider Network Senior |
$77.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.45
|
| Rate for Payer: Multiplan Commercial |
$85.36
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
OP
|
$113.81
|
|
|
Service Code
|
NDC 7297412001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$96.74 |
| Rate for Payer: Adventist Health Commercial |
$22.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.93
|
| Rate for Payer: Blue Shield of California Commercial |
$69.42
|
| Rate for Payer: Blue Shield of California EPN |
$55.54
|
| Rate for Payer: Cash Price |
$51.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.45
|
| Rate for Payer: Heritage Provider Network Senior |
$70.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$54.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.67
|
| Rate for Payer: Multiplan Commercial |
$85.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$45.52
|
| Rate for Payer: TriValley Medical Group Senior |
$45.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$56.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$56.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.74
|
| Rate for Payer: Vantage Medical Group Senior |
$96.74
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]
|
Facility
|
OP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$637.77 |
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$525.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.57
|
| Rate for Payer: Blue Shield of California Commercial |
$6.11
|
| Rate for Payer: Blue Shield of California EPN |
$6.11
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$391.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$393.72
|
| Rate for Payer: Heritage Provider Network Senior |
$393.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$405.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.06
|
| Rate for Payer: Multiplan Commercial |
$637.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$340.14
|
| Rate for Payer: TriValley Medical Group Senior |
$340.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$281.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8.26
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]
|
Facility
|
IP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.92 |
| Max. Negotiated Rate |
$637.77 |
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$547.63
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$391.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$393.72
|
| Rate for Payer: Heritage Provider Network Senior |
$393.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.59
|
| Rate for Payer: Multiplan Commercial |
$637.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$281.55
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
IP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.92 |
| Max. Negotiated Rate |
$637.77 |
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$547.63
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$391.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$393.72
|
| Rate for Payer: Heritage Provider Network Senior |
$393.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.59
|
| Rate for Payer: Multiplan Commercial |
$637.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$281.55
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
OP
|
$850.36
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$637.77 |
| Rate for Payer: Adventist Health Commercial |
$170.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$525.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.57
|
| Rate for Payer: Blue Shield of California Commercial |
$6.11
|
| Rate for Payer: Blue Shield of California EPN |
$6.11
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$391.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$393.72
|
| Rate for Payer: Heritage Provider Network Senior |
$393.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$405.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.06
|
| Rate for Payer: Multiplan Commercial |
$637.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$340.14
|
| Rate for Payer: TriValley Medical Group Senior |
$340.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$281.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8.26
|
|
|
REMESTEMCEL-L-RKND 6.68 X 10EXP6 CELL/ML INTRAVENOUS SUSPENSION [245044]
|
Facility
|
IP
|
$232,800.00
|
|
|
Service Code
|
HCPCS J3402
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42,136.80 |
| Max. Negotiated Rate |
$174,600.00 |
| Rate for Payer: Adventist Health Commercial |
$46,560.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149,923.20
|
| Rate for Payer: Cash Price |
$104,760.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107,088.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$125,712.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$107,786.40
|
| Rate for Payer: Heritage Provider Network Senior |
$107,786.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,136.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58,200.00
|
| Rate for Payer: Multiplan Commercial |
$174,600.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$84,110.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77,080.08
|
|
|
REMESTEMCEL-L-RKND 6.68 X 10EXP6 CELL/ML INTRAVENOUS SUSPENSION [245044]
|
Facility
|
OP
|
$232,800.00
|
|
|
Service Code
|
HCPCS J3402
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42,136.80 |
| Max. Negotiated Rate |
$305,489.64 |
| Rate for Payer: Adventist Health Commercial |
$46,560.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143,870.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305,489.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224,025.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$203,659.76
|
| Rate for Payer: Blue Shield of California Commercial |
$142,008.00
|
| Rate for Payer: Blue Shield of California EPN |
$113,606.40
|
| Rate for Payer: Cash Price |
$104,760.00
|
| Rate for Payer: Cash Price |
$104,760.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107,088.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305,489.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$224,025.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$203,659.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$148,992.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$203,659.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$107,786.40
|
| Rate for Payer: Heritage Provider Network Senior |
$107,786.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$203,659.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$111,045.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,136.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234,208.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$272,904.08
|
| Rate for Payer: Multiplan Commercial |
$174,600.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$93,120.00
|
| Rate for Payer: TriValley Medical Group Senior |
$93,120.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$84,110.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77,080.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305,489.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224,025.74
|
| Rate for Payer: Vantage Medical Group Senior |
$203,659.76
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$80.83
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.62
|
| Rate for Payer: Blue Shield of California Commercial |
$49.31
|
| Rate for Payer: Blue Shield of California Commercial |
$53.66
|
| Rate for Payer: Blue Shield of California EPN |
$42.93
|
| Rate for Payer: Blue Shield of California EPN |
$39.45
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cash Price |
$36.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.73
|
| Rate for Payer: Heritage Provider Network Senior |
$37.42
|
| Rate for Payer: Heritage Provider Network Senior |
$40.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$38.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.58
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
| Rate for Payer: Multiplan Commercial |
$60.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.19
|
| Rate for Payer: TriValley Medical Group Senior |
$32.33
|
| Rate for Payer: TriValley Medical Group Senior |
$35.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.77
|
| Rate for Payer: Vantage Medical Group Senior |
$74.77
|
| Rate for Payer: Vantage Medical Group Senior |
$68.71
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$87.97
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$65.98 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.65
|
| Rate for Payer: Cash Price |
$36.37
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.73
|
| Rate for Payer: Heritage Provider Network Senior |
$40.73
|
| Rate for Payer: Heritage Provider Network Senior |
$37.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.99
|
| Rate for Payer: Multiplan Commercial |
$60.62
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.76
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
IP
|
$161.66
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.26 |
| Max. Negotiated Rate |
$121.25 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.67
|
| Rate for Payer: Cash Price |
$72.75
|
| Rate for Payer: Cash Price |
$69.45
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.46
|
| Rate for Payer: Heritage Provider Network Senior |
$71.46
|
| Rate for Payer: Heritage Provider Network Senior |
$68.06
|
| Rate for Payer: Heritage Provider Network Senior |
$74.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$53.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.10
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Adventist Health Commercial |
$30.87
|
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.75
|
| Rate for Payer: Blue Shield of California Commercial |
$89.67
|
| Rate for Payer: Blue Shield of California Commercial |
$98.61
|
| Rate for Payer: Blue Shield of California Commercial |
$94.15
|
| Rate for Payer: Blue Shield of California EPN |
$71.74
|
| Rate for Payer: Blue Shield of California EPN |
$75.32
|
| Rate for Payer: Blue Shield of California EPN |
$78.89
|
| Rate for Payer: Cash Price |
$72.75
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$69.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.85
|
| Rate for Payer: Heritage Provider Network Senior |
$71.46
|
| Rate for Payer: Heritage Provider Network Senior |
$68.06
|
| Rate for Payer: Heritage Provider Network Senior |
$74.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$73.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$77.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$70.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$108.04
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$115.75
|
| Rate for Payer: Multiplan Commercial |
$121.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$61.74
|
| Rate for Payer: TriValley Medical Group Senior |
$61.74
|
| Rate for Payer: TriValley Medical Group Senior |
$64.66
|
| Rate for Payer: TriValley Medical Group Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$53.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.41
|
| Rate for Payer: Vantage Medical Group Senior |
$137.41
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$131.19
|
|
|
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$574.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$574.56
|
| Rate for Payer: Heritage Provider Network Senior |
$706.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,091.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$632.02
|
| Rate for Payer: TriValley Medical Group Senior |
$632.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
|
|
REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA
|
Facility
|
OP
|
$10,829.24
|
|
|
Service Code
|
CPT 27372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,735.95 |
| Max. Negotiated Rate |
$10,829.24 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,735.95
|
| Rate for Payer: Heritage Provider Network Senior |
$4,595.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,098.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,296.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,109.55
|
| Rate for Payer: TriValley Medical Group Senior |
$4,109.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 28190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$910.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
