|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]
|
Facility
|
IP
|
$1,341.68
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$268.34 |
| Max. Negotiated Rate |
$1,140.43 |
| Rate for Payer: Adventist Health Commercial |
$268.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,031.75
|
| Rate for Payer: Blue Shield of California Commercial |
$680.23
|
| Rate for Payer: Cash Price |
$603.76
|
| Rate for Payer: Cigna of CA HMO |
$939.18
|
| Rate for Payer: Cigna of CA PPO |
$939.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$939.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.67
|
| Rate for Payer: EPIC Health Plan Senior |
$536.67
|
| Rate for Payer: Galaxy Health WC |
$1,140.43
|
| Rate for Payer: Global Benefits Group Commercial |
$805.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$851.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$791.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$1,073.34
|
| Rate for Payer: Networks By Design Commercial |
$670.84
|
| Rate for Payer: Prime Health Services Commercial |
$1,140.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.53
|
| Rate for Payer: United Healthcare All Other HMO |
$490.12
|
| Rate for Payer: United Healthcare HMO Rider |
$479.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$439.40
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]
|
Facility
|
OP
|
$1,341.68
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$264.45 |
| Max. Negotiated Rate |
$2,329.97 |
| Rate for Payer: Adventist Health Commercial |
$268.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,329.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.45
|
| Rate for Payer: Blue Shield of California Commercial |
$429.81
|
| Rate for Payer: Cash Price |
$603.76
|
| Rate for Payer: Cash Price |
$603.76
|
| Rate for Payer: Cigna of CA HMO |
$939.18
|
| Rate for Payer: Cigna of CA PPO |
$939.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$426.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$426.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$939.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$639.29
|
| Rate for Payer: EPIC Health Plan Senior |
$426.19
|
| Rate for Payer: Galaxy Health WC |
$1,140.43
|
| Rate for Payer: Global Benefits Group Commercial |
$805.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$635.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$387.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$387.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$851.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$487.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$542.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$488.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$519.18
|
| Rate for Payer: Multiplan Commercial |
$1,073.34
|
| Rate for Payer: Networks By Design Commercial |
$670.84
|
| Rate for Payer: Prime Health Services Commercial |
$1,140.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$805.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$805.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.53
|
| Rate for Payer: United Healthcare All Other HMO |
$490.12
|
| Rate for Payer: United Healthcare HMO Rider |
$479.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$439.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$387.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$426.19
|
| Rate for Payer: Vantage Medical Group Senior |
$426.19
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION [229668]
|
Facility
|
OP
|
$2,678.15
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$2,276.43 |
| Rate for Payer: Adventist Health Commercial |
$535.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,385.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$545.37
|
| Rate for Payer: Blue Shield of California Commercial |
$256.16
|
| Rate for Payer: Cash Price |
$1,205.17
|
| Rate for Payer: Cash Price |
$1,205.17
|
| Rate for Payer: Cigna of CA HMO |
$1,874.70
|
| Rate for Payer: Cigna of CA PPO |
$1,874.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,874.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.42
|
| Rate for Payer: EPIC Health Plan Senior |
$249.61
|
| Rate for Payer: Galaxy Health WC |
$2,276.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1,606.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$372.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,700.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$317.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.07
|
| Rate for Payer: Multiplan Commercial |
$2,142.52
|
| Rate for Payer: Networks By Design Commercial |
$1,339.08
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,606.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,606.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,005.11
|
| Rate for Payer: United Healthcare All Other HMO |
$978.33
|
| Rate for Payer: United Healthcare HMO Rider |
$957.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$877.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$283.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.61
|
| Rate for Payer: Vantage Medical Group Senior |
$249.61
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION [229668]
|
Facility
|
IP
|
$2,678.15
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$535.63 |
| Max. Negotiated Rate |
$2,276.43 |
| Rate for Payer: Adventist Health Commercial |
$535.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,357.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,059.50
|
| Rate for Payer: Cash Price |
$1,205.17
|
| Rate for Payer: Cigna of CA HMO |
$1,874.70
|
| Rate for Payer: Cigna of CA PPO |
$1,874.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,874.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,071.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1,071.26
|
| Rate for Payer: Galaxy Health WC |
$2,276.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1,606.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,700.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,580.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.76
|
| Rate for Payer: Multiplan Commercial |
$2,142.52
|
| Rate for Payer: Networks By Design Commercial |
$1,339.08
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,005.11
|
| Rate for Payer: United Healthcare All Other HMO |
$978.33
|
| Rate for Payer: United Healthcare HMO Rider |
$957.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$877.09
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; 3 OR MORE PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, REQUIRING BONE GRAFTS (INCLUDES OBTAINING AUTOGRAFTS) (EG, UNGRAFTED BILATERAL ALVEOLAR CLEFT OR MULTIPLE OSTEOTOMIES)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 21147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.28 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$375.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,202.61
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| 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
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY DIRECTION (EG, FOR LONG FACE SYNDROME), WITHOUT BONE GRAFT
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 21141
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,746.29 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| 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 Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,746.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,974.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| 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
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY DIRECTION, REQUIRING BONE GRAFTS (INCLUDES OBTAINING AUTOGRAFTS)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 21145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$311.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| 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 Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,202.61
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| 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
|
|
|
RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL SPLIT; WITH INTERNAL RIGID FIXATION
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 21196
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,751.30 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| 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 Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,751.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,980.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| 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
|
|
|
RECONSTRUCTION OF POLYDACTYLOUS DIGIT, SOFT TISSUE AND BONE
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 26587
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,122.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
RECONSTRUCTION, TOE(S); POLYDACTYLY
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 28344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$107.59 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
RECONSTRUCTION, TOE(S); SYNDACTYLY, WITH OR WITHOUT SKIN GRAFT(S), EACH WEB
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 28345
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$695.52 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$695.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$786.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,895.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$120,811.55
|
|
|
Service Code
|
MSDRG 333
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$120,811.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71,006.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$120,811.55
|
| Rate for Payer: EPIC Health Plan Senior |
$80,541.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73,219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102,506.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98,113.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$143,498.31
|
|
|
Service Code
|
MSDRG 332
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$143,498.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109,765.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$143,498.31
|
| Rate for Payer: EPIC Health Plan Senior |
$95,665.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$86,968.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$121,756.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116,538.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
RECTAL RESECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$108,313.87
|
|
|
Service Code
|
MSDRG 334
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$108,313.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,654.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$108,313.87
|
| Rate for Payer: EPIC Health Plan Senior |
$72,209.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,644.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91,902.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,963.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$104,168.67
|
|
|
Service Code
|
MSDRG 811
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$104,168.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,572.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$104,168.67
|
| Rate for Payer: EPIC Health Plan Senior |
$69,445.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,132.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,385.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,597.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$95,542.90
|
|
|
Service Code
|
MSDRG 812
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$95,542.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,836.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$95,542.90
|
| Rate for Payer: EPIC Health Plan Senior |
$63,695.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,904.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,066.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77,592.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 54600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$566.66 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$566.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,712.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,075.17
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
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 |
$0.96 |
| Max. Negotiated Rate |
$134.79 |
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| 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 |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.79
|
| Rate for Payer: Blue Shield of California Commercial |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.00
|
| 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 |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| 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 |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.69
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
|
|
REHABILITATION
|
Facility
|
IP
|
$15,835.57
|
|
|
Service Code
|
APR-DRG 8601
|
| Min. Negotiated Rate |
$12,647.62 |
| Max. Negotiated Rate |
$15,835.57 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,647.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,835.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,168.67
|
|
|
REHABILITATION
|
Facility
|
IP
|
$19,036.12
|
|
|
Service Code
|
APR-DRG 8602
|
| Min. Negotiated Rate |
$15,203.85 |
| Max. Negotiated Rate |
$19,036.12 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,203.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,036.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,032.32
|
|
|
REHABILITATION
|
Facility
|
IP
|
$30,776.83
|
|
|
Service Code
|
APR-DRG 8604
|
| Min. Negotiated Rate |
$24,580.97 |
| Max. Negotiated Rate |
$30,776.83 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24,580.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30,776.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,537.16
|
|
|
REHABILITATION
|
Facility
|
IP
|
$24,820.86
|
|
|
Service Code
|
APR-DRG 8603
|
| Min. Negotiated Rate |
$19,824.03 |
| Max. Negotiated Rate |
$24,820.86 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,824.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,820.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,208.14
|
|
|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$106,729.24
|
|
|
Service Code
|
MSDRG 945
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$106,729.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,947.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$106,729.24
|
| Rate for Payer: EPIC Health Plan Senior |
$71,152.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64,684.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90,558.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86,677.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$99,599.40
|
|
|
Service Code
|
MSDRG 946
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$99,599.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,766.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$99,599.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66,399.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,363.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,508.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80,886.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
