|
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); DEEP (EG, ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS, OR PERONEAL TENDON TO MIDFOOT OR HINDFOOT)
|
Facility
|
OP
|
$17,732.13
|
|
|
Service Code
|
CPT 27691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$17,732.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| 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 |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); SUPERFICIAL (EG, ANTERIOR TIBIAL EXTENSORS INTO MIDFOOT)
|
Facility
|
OP
|
$17,732.13
|
|
|
Service Code
|
CPT 27690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$17,732.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| 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 |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC
|
Facility
|
IP
|
$18,576.00
|
|
|
Service Code
|
MSDRG 069
|
| Min. Negotiated Rate |
$9,677.28 |
| Max. Negotiated Rate |
$18,576.00 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,677.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,677.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,128.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,967.56
|
|
|
TRANSLUMINAL BALLOON ANGIOPLASTY, CENTRAL DIALYSIS SEGMENT, PERFORMED THROUGH DIALYSIS CIRCUIT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION REQUIRED TO PERFORM THE ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 36907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
|
|
TRANSMASTOID ANTROTOMY (SIMPLE MASTOIDECTOMY)
|
Facility
|
OP
|
$14,466.39
|
|
|
Service Code
|
CPT 69501
|
|
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 |
$11,108.00
|
| 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
|
|
|
TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$13,102.72
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,245.00 |
| Max. Negotiated Rate |
$13,102.72 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,896.17
|
| 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 |
$10,344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,585.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,896.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,896.17
|
| Rate for Payer: Heritage Provider Network Senior |
$8,482.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,102.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,930.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,240.87
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,585.79
|
| Rate for Payer: TriValley Medical Group Senior |
$7,585.79
|
| 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 |
$10,344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6,896.17
|
|
|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
|
IP
|
$24,533.28
|
|
|
Service Code
|
MSDRG 669
|
| Min. Negotiated Rate |
$18,308.42 |
| Max. Negotiated Rate |
$24,533.28 |
| Rate for Payer: EPIC Health Plan Medicare |
$18,308.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,308.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,054.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24,533.28
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$45,539.57
|
|
|
Service Code
|
MSDRG 668
|
| Min. Negotiated Rate |
$33,984.75 |
| Max. Negotiated Rate |
$45,539.57 |
| Rate for Payer: EPIC Health Plan Medicare |
$33,984.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,984.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39,082.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,539.57
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,708.50
|
|
|
Service Code
|
MSDRG 670
|
| Min. Negotiated Rate |
$11,722.76 |
| Max. Negotiated Rate |
$15,708.50 |
| Rate for Payer: EPIC Health Plan Medicare |
$11,722.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,722.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,481.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,708.50
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
|
IP
|
$23,787.00
|
|
|
Service Code
|
MSDRG 713
|
| Min. Negotiated Rate |
$17,751.49 |
| Max. Negotiated Rate |
$23,787.00 |
| Rate for Payer: EPIC Health Plan Medicare |
$17,751.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,751.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,414.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,787.00
|
|
|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$16,938.47
|
|
|
Service Code
|
MSDRG 714
|
| Min. Negotiated Rate |
$12,640.65 |
| Max. Negotiated Rate |
$16,938.47 |
| Rate for Payer: EPIC Health Plan Medicare |
$12,640.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,640.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,536.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,938.47
|
|
|
TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) BILATERAL; BY INJECTIONS (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT 64488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$8,962.13 |
| 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: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
|
|
TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) UNILATERAL; BY INJECTION(S) (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT 64486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$8,962.13 |
| 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: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [216113]
|
Facility
|
IP
|
$1,870.10
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.49 |
| Max. Negotiated Rate |
$1,402.58 |
| Rate for Payer: Adventist Health Commercial |
$374.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,204.34
|
| Rate for Payer: Cash Price |
$841.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$860.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,009.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$865.86
|
| Rate for Payer: Heritage Provider Network Senior |
$865.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$338.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.52
|
| Rate for Payer: Multiplan Commercial |
$1,402.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$675.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$619.19
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [216113]
|
Facility
|
OP
|
$1,870.10
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.24 |
| Max. Negotiated Rate |
$1,402.58 |
| Rate for Payer: Adventist Health Commercial |
$374.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,155.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.30
|
| Rate for Payer: Blue Shield of California Commercial |
$105.97
|
| Rate for Payer: Blue Shield of California EPN |
$105.97
|
| Rate for Payer: Cash Price |
$841.54
|
| Rate for Payer: Cash Price |
$841.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$860.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,196.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$70.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$865.86
|
| Rate for Payer: Heritage Provider Network Senior |
$865.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$892.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$338.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.12
|
| Rate for Payer: Multiplan Commercial |
$1,402.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$748.04
|
| Rate for Payer: TriValley Medical Group Senior |
$748.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$675.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$619.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.26
|
| Rate for Payer: Vantage Medical Group Senior |
$77.26
|
|
|
TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION [224561]
|
Facility
|
IP
|
$1,122.06
|
|
|
Service Code
|
HCPCS J9356
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.09 |
| Max. Negotiated Rate |
$841.54 |
| Rate for Payer: Adventist Health Commercial |
$224.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$722.61
|
| Rate for Payer: Cash Price |
$504.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$519.51
|
| Rate for Payer: Heritage Provider Network Senior |
$519.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$203.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.51
|
| Rate for Payer: Multiplan Commercial |
$841.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$405.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$371.51
|
|
|
TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION [224561]
|
Facility
|
OP
|
$1,122.06
|
|
|
Service Code
|
HCPCS J9356
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$841.54 |
| Rate for Payer: Adventist Health Commercial |
$224.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$693.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.88
|
| Rate for Payer: Blue Shield of California Commercial |
$79.47
|
| Rate for Payer: Blue Shield of California EPN |
$79.47
|
| Rate for Payer: Cash Price |
$504.93
|
| Rate for Payer: Cash Price |
$504.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$58.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$519.51
|
| Rate for Payer: Heritage Provider Network Senior |
$519.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$535.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$203.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.18
|
| Rate for Payer: Multiplan Commercial |
$841.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$448.82
|
| Rate for Payer: TriValley Medical Group Senior |
$448.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$405.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$371.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.17
|
| Rate for Payer: Vantage Medical Group Senior |
$64.17
|
|
|
TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION [226189]
|
Facility
|
OP
|
$1,632.08
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.52 |
| Max. Negotiated Rate |
$1,224.06 |
| Rate for Payer: Adventist Health Commercial |
$326.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,008.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.42
|
| Rate for Payer: Blue Shield of California Commercial |
$92.49
|
| Rate for Payer: Blue Shield of California EPN |
$92.49
|
| Rate for Payer: Cash Price |
$734.44
|
| Rate for Payer: Cash Price |
$734.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$750.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$755.65
|
| Rate for Payer: Heritage Provider Network Senior |
$755.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$778.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$295.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$81.10
|
| Rate for Payer: Multiplan Commercial |
$1,224.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$652.83
|
| Rate for Payer: TriValley Medical Group Senior |
$652.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$589.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$540.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.57
|
| Rate for Payer: Vantage Medical Group Senior |
$66.57
|
|
|
TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION [226189]
|
Facility
|
IP
|
$1,632.08
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$295.41 |
| Max. Negotiated Rate |
$1,224.06 |
| Rate for Payer: Adventist Health Commercial |
$326.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,051.06
|
| Rate for Payer: Cash Price |
$734.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$750.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$755.65
|
| Rate for Payer: Heritage Provider Network Senior |
$755.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$295.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.02
|
| Rate for Payer: Multiplan Commercial |
$1,224.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$589.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$540.38
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION [225307]
|
Facility
|
IP
|
$4,569.82
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$827.14 |
| Max. Negotiated Rate |
$3,427.36 |
| Rate for Payer: Adventist Health Commercial |
$913.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,942.96
|
| Rate for Payer: Cash Price |
$2,056.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,102.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,467.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,115.83
|
| Rate for Payer: Heritage Provider Network Senior |
$2,115.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$827.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.45
|
| Rate for Payer: Multiplan Commercial |
$3,427.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,651.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,513.07
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION [225307]
|
Facility
|
OP
|
$4,569.82
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.52 |
| Max. Negotiated Rate |
$3,427.36 |
| Rate for Payer: Adventist Health Commercial |
$913.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,824.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.42
|
| Rate for Payer: Blue Shield of California Commercial |
$92.49
|
| Rate for Payer: Blue Shield of California EPN |
$92.49
|
| Rate for Payer: Cash Price |
$2,056.42
|
| Rate for Payer: Cash Price |
$2,056.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,102.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,924.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,115.83
|
| Rate for Payer: Heritage Provider Network Senior |
$2,115.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,179.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$827.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$81.10
|
| Rate for Payer: Multiplan Commercial |
$3,427.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,827.93
|
| Rate for Payer: TriValley Medical Group Senior |
$1,827.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,651.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,513.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.57
|
| Rate for Payer: Vantage Medical Group Senior |
$66.57
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$25,801.63
|
|
|
Service Code
|
MSDRG 913
|
| Min. Negotiated Rate |
$19,254.95 |
| Max. Negotiated Rate |
$25,801.63 |
| Rate for Payer: EPIC Health Plan Medicare |
$19,254.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,254.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,143.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,801.63
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$14,298.86
|
|
|
Service Code
|
MSDRG 914
|
| Min. Negotiated Rate |
$10,670.79 |
| Max. Negotiated Rate |
$14,298.86 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,670.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,670.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,271.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,298.86
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
|
IP
|
$20,705.17
|
|
|
Service Code
|
MSDRG 086
|
| Min. Negotiated Rate |
$15,451.62 |
| Max. Negotiated Rate |
$20,705.17 |
| Rate for Payer: EPIC Health Plan Medicare |
$15,451.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,451.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,769.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,705.17
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
|
IP
|
$22,134.76
|
|
|
Service Code
|
MSDRG 083
|
| Min. Negotiated Rate |
$16,518.48 |
| Max. Negotiated Rate |
$22,134.76 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,518.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,518.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,996.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,134.76
|
|
