|
THIOTEPA 15 MG SOLUTION FOR INJECTION [7901]
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS J9342
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.25
|
| Rate for Payer: Blue Shield of California Commercial |
$128.10
|
| Rate for Payer: Blue Shield of California EPN |
$102.48
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.23
|
| Rate for Payer: Heritage Provider Network Senior |
$97.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$100.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4.93
|
|
|
THIOTEPA 15 MG SOLUTION FOR INJECTION [7901]
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS J9342
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.24
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.23
|
| Rate for Payer: Heritage Provider Network Senior |
$97.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.53
|
|
|
THORACIC FASCIAL PLANE BLOCK, UNILATERAL; BY INJECTION(S), INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT 64466
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
|
|
THROMBIN(HUMAN)-FIBRINOGEN-APROTININ SYN-CALCIUM 10 ML TOPICAL SYRINGE [221104]
|
Facility
|
IP
|
$85.86
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$64.39 |
| Rate for Payer: Adventist Health Commercial |
$17.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.29
|
| Rate for Payer: Cash Price |
$38.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.75
|
| Rate for Payer: Heritage Provider Network Senior |
$39.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.46
|
| Rate for Payer: Multiplan Commercial |
$64.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.43
|
|
|
THROMBIN(HUMAN)-FIBRINOGEN-APROTININ SYN-CALCIUM 10 ML TOPICAL SYRINGE [221104]
|
Facility
|
OP
|
$85.86
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$72.98 |
| Rate for Payer: Adventist Health Commercial |
$17.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.39
|
| Rate for Payer: Blue Shield of California Commercial |
$52.37
|
| Rate for Payer: Blue Shield of California EPN |
$41.90
|
| Rate for Payer: Cash Price |
$38.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.75
|
| Rate for Payer: Heritage Provider Network Senior |
$39.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.10
|
| Rate for Payer: Multiplan Commercial |
$64.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.34
|
| Rate for Payer: TriValley Medical Group Senior |
$34.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.98
|
| Rate for Payer: Vantage Medical Group Senior |
$72.98
|
|
|
THROMBIN(HUMAN)-FIBRINOGEN-APROTININ SYN-CALCIUM 4 ML TOPICAL SYRINGE [221103]
|
Facility
|
IP
|
$87.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$65.62 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.34
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.51
|
| Rate for Payer: Heritage Provider Network Senior |
$40.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.87
|
| Rate for Payer: Multiplan Commercial |
$65.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.97
|
|
|
THROMBIN(HUMAN)-FIBRINOGEN-APROTININ SYN-CALCIUM 4 ML TOPICAL SYRINGE [221103]
|
Facility
|
OP
|
$87.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.62
|
| Rate for Payer: Blue Shield of California Commercial |
$53.37
|
| Rate for Payer: Blue Shield of California EPN |
$42.70
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.51
|
| Rate for Payer: Heritage Provider Network Senior |
$40.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$65.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.00
|
| Rate for Payer: TriValley Medical Group Senior |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.37
|
| Rate for Payer: Vantage Medical Group Senior |
$74.37
|
|
|
THROMBIN(HUMAN)-FIBRINOGEN-APROTININ SYNTHETC-CALCIUM 4 ML TOPICAL KIT [221085]
|
Facility
|
OP
|
$382.67
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.26 |
| Max. Negotiated Rate |
$325.27 |
| Rate for Payer: Adventist Health Commercial |
$76.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$236.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.41
|
| Rate for Payer: Blue Shield of California Commercial |
$233.43
|
| Rate for Payer: Blue Shield of California EPN |
$186.74
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.18
|
| Rate for Payer: Heritage Provider Network Senior |
$177.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$182.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$267.87
|
| Rate for Payer: Multiplan Commercial |
$287.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$153.07
|
| Rate for Payer: TriValley Medical Group Senior |
$153.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$138.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$126.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.27
|
| Rate for Payer: Vantage Medical Group Senior |
$325.27
|
|
|
THROMBIN(HUMAN)-FIBRINOGEN-APROTININ SYNTHETC-CALCIUM 4 ML TOPICAL KIT [221085]
|
Facility
|
IP
|
$382.67
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.26 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Adventist Health Commercial |
$76.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$246.44
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.18
|
| Rate for Payer: Heritage Provider Network Senior |
$177.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.67
|
| Rate for Payer: Multiplan Commercial |
$287.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$138.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$126.70
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]
|
Facility
|
IP
|
$103.20
|
|
|
Service Code
|
NDC 0338032201
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Adventist Health Commercial |
$20.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.46
|
| Rate for Payer: Cash Price |
$46.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.87
|
| Rate for Payer: Heritage Provider Network Senior |
$69.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$77.40
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]
|
Facility
|
OP
|
$103.20
|
|
|
Service Code
|
NDC 0338032201
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$20.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.62
|
| Rate for Payer: Blue Shield of California Commercial |
$62.95
|
| Rate for Payer: Blue Shield of California EPN |
$50.36
|
| Rate for Payer: Cash Price |
$46.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.88
|
| Rate for Payer: Heritage Provider Network Senior |
$63.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$72.24
|
| Rate for Payer: Multiplan Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.28
|
| Rate for Payer: TriValley Medical Group Senior |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.72
|
| Rate for Payer: Vantage Medical Group Senior |
$87.72
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]
|
Facility
|
OP
|
$103.20
|
|
|
Service Code
|
NDC 0338032401
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$20.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.62
|
| Rate for Payer: Blue Shield of California Commercial |
$62.95
|
| Rate for Payer: Blue Shield of California EPN |
$50.36
|
| Rate for Payer: Cash Price |
$46.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.88
|
| Rate for Payer: Heritage Provider Network Senior |
$63.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$72.24
|
| Rate for Payer: Multiplan Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.28
|
| Rate for Payer: TriValley Medical Group Senior |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.72
|
| Rate for Payer: Vantage Medical Group Senior |
$87.72
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]
|
Facility
|
IP
|
$103.20
|
|
|
Service Code
|
NDC 0338032401
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Adventist Health Commercial |
$20.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.46
|
| Rate for Payer: Cash Price |
$46.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.87
|
| Rate for Payer: Heritage Provider Network Senior |
$69.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$77.40
|
|
|
THYROIDECTOMY, REMOVAL OF ALL REMAINING THYROID TISSUE FOLLOWING PREVIOUS REMOVAL OF A PORTION OF THYROID
|
Facility
|
OP
|
$14,466.39
|
|
|
Service Code
|
CPT 60260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,613.89 |
| 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 |
$9,728.00
|
| 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 |
$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
|
|
|
THYROIDECTOMY, TOTAL OR COMPLETE
|
Facility
|
OP
|
$14,773.56
|
|
|
Service Code
|
CPT 60240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,775.56 |
| Max. Negotiated Rate |
$14,773.56 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| 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 |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,775.56
|
| Rate for Payer: Heritage Provider Network Senior |
$9,563.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,773.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,941.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,553.12
|
| Rate for Payer: TriValley Medical Group Senior |
$8,553.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH LIMITED NECK DISSECTION
|
Facility
|
OP
|
$14,466.39
|
|
|
Service Code
|
CPT 60252
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,613.89 |
| 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 |
$8,435.00
|
| 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 |
$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
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC
|
Facility
|
IP
|
$23,725.57
|
|
|
Service Code
|
MSDRG 626
|
| Min. Negotiated Rate |
$17,705.65 |
| Max. Negotiated Rate |
$23,725.57 |
| Rate for Payer: EPIC Health Plan Medicare |
$17,705.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,705.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,361.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,725.57
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$47,076.63
|
|
|
Service Code
|
MSDRG 625
|
| Min. Negotiated Rate |
$35,131.81 |
| Max. Negotiated Rate |
$47,076.63 |
| Rate for Payer: EPIC Health Plan Medicare |
$35,131.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35,131.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40,401.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47,076.63
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,098.26
|
|
|
Service Code
|
MSDRG 627
|
| Min. Negotiated Rate |
$15,744.97 |
| Max. Negotiated Rate |
$21,098.26 |
| Rate for Payer: EPIC Health Plan Medicare |
$15,744.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,744.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,106.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,098.26
|
|
|
THYROID (PORK) 15 MG TABLET [120628]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 7583431001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
THYROID (PORK) 15 MG TABLET [120628]
|
Facility
|
OP
|
$0.70
|
|
|
Service Code
|
NDC 4219232701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
THYROID (PORK) 15 MG TABLET [120628]
|
Facility
|
IP
|
$0.70
|
|
|
Service Code
|
NDC 4219232701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
|
|
THYROID (PORK) 15 MG TABLET [120628]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 7583431001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.40
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
|
|
THYROID (PORK) 180 MG TABLET [120633]
|
Facility
|
OP
|
$1.94
|
|
|
Service Code
|
NDC 0456046201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.78
|
| Rate for Payer: TriValley Medical Group Senior |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1.65
|
|
|
THYROID (PORK) 180 MG TABLET [120633]
|
Facility
|
IP
|
$1.94
|
|
|
Service Code
|
NDC 0456046201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.25
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
|
