|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$150,605.51
|
|
|
Service Code
|
APR-DRG 4014
|
| Min. Negotiated Rate |
$120,286.25 |
| Max. Negotiated Rate |
$150,605.51 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120,286.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150,605.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134,752.30
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$33,540.79
|
|
|
Service Code
|
APR-DRG 4012
|
| Min. Negotiated Rate |
$26,788.50 |
| Max. Negotiated Rate |
$33,540.79 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,788.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,540.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,010.19
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$61,781.96
|
|
|
Service Code
|
APR-DRG 4013
|
| Min. Negotiated Rate |
$49,344.27 |
| Max. Negotiated Rate |
$61,781.96 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49,344.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61,781.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55,278.59
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$25,880.93
|
|
|
Service Code
|
APR-DRG 4011
|
| Min. Negotiated Rate |
$20,670.69 |
| Max. Negotiated Rate |
$25,880.93 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,670.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,880.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,156.62
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [152966]
|
Facility
|
OP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$743.61 |
| Max. Negotiated Rate |
$40,812.24 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,005.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$817.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,363.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,110.00
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cigna of CA HMO |
$33,610.08
|
| Rate for Payer: Cigna of CA PPO |
$33,610.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$817.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$817.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,610.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,226.96
|
| Rate for Payer: EPIC Health Plan Senior |
$817.97
|
| Rate for Payer: Galaxy Health WC |
$40,812.24
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,219.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$743.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$743.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,489.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,451.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,041.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,523.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$936.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$996.44
|
| Rate for Payer: Multiplan Commercial |
$38,411.52
|
| Rate for Payer: Networks By Design Commercial |
$24,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$40,812.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,808.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,808.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,019.80
|
| Rate for Payer: United Healthcare All Other HMO |
$17,539.66
|
| Rate for Payer: United Healthcare HMO Rider |
$17,160.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,724.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$743.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Vantage Medical Group Senior |
$817.97
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [152966]
|
Facility
|
IP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,602.88 |
| Max. Negotiated Rate |
$40,812.24 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Blue Shield of California Commercial |
$24,343.30
|
| Rate for Payer: Blue Shield of California Commercial |
$36,923.07
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cigna of CA HMO |
$33,610.08
|
| Rate for Payer: Cigna of CA PPO |
$33,610.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,610.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,205.76
|
| Rate for Payer: EPIC Health Plan Senior |
$19,205.76
|
| Rate for Payer: Galaxy Health WC |
$40,812.24
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,489.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,328.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,523.46
|
| Rate for Payer: Multiplan Commercial |
$38,411.52
|
| Rate for Payer: Networks By Design Commercial |
$24,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$40,812.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,019.80
|
| Rate for Payer: United Healthcare All Other HMO |
$17,539.66
|
| Rate for Payer: United Healthcare HMO Rider |
$17,160.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,724.72
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SYRINGE [226632]
|
Facility
|
OP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$743.61 |
| Max. Negotiated Rate |
$40,812.24 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,005.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$817.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,363.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,110.00
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cigna of CA HMO |
$33,610.08
|
| Rate for Payer: Cigna of CA PPO |
$33,610.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$817.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$817.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,610.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,226.96
|
| Rate for Payer: EPIC Health Plan Senior |
$817.97
|
| Rate for Payer: Galaxy Health WC |
$40,812.24
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,219.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$743.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$743.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,489.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,451.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,041.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,523.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$936.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$996.44
|
| Rate for Payer: Multiplan Commercial |
$38,411.52
|
| Rate for Payer: Networks By Design Commercial |
$24,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$40,812.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,808.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,808.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,019.80
|
| Rate for Payer: United Healthcare All Other HMO |
$17,539.66
|
| Rate for Payer: United Healthcare HMO Rider |
$17,160.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,724.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$743.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$817.97
|
| Rate for Payer: Vantage Medical Group Senior |
$817.97
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SYRINGE [226632]
|
Facility
|
IP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,602.88 |
| Max. Negotiated Rate |
$40,812.24 |
| Rate for Payer: Adventist Health Commercial |
$9,602.88
|
| Rate for Payer: Blue Shield of California Commercial |
$24,343.30
|
| Rate for Payer: Blue Shield of California Commercial |
$36,923.07
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cigna of CA HMO |
$33,610.08
|
| Rate for Payer: Cigna of CA PPO |
$33,610.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,610.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,205.76
|
| Rate for Payer: EPIC Health Plan Senior |
$19,205.76
|
| Rate for Payer: Galaxy Health WC |
$40,812.24
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,489.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,328.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,523.46
|
| Rate for Payer: Multiplan Commercial |
$38,411.52
|
| Rate for Payer: Networks By Design Commercial |
$24,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$40,812.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,019.80
|
| Rate for Payer: United Healthcare All Other HMO |
$17,539.66
|
| Rate for Payer: United Healthcare HMO Rider |
$17,160.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,724.72
|
|
|
AFLIBERCEPT 8 MG/0.07 ML INTRAVITREAL SOLUTION FOR INJECTION [239224]
|
Facility
|
IP
|
$48,222.51
|
|
|
Service Code
|
HCPCS J0177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,644.50 |
| Max. Negotiated Rate |
$40,989.13 |
| Rate for Payer: Adventist Health Commercial |
$9,644.50
|
| Rate for Payer: Blue Shield of California Commercial |
$24,448.81
|
| Rate for Payer: Blue Shield of California Commercial |
$37,083.11
|
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Cigna of CA HMO |
$33,755.76
|
| Rate for Payer: Cigna of CA PPO |
$33,755.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,755.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,289.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,289.00
|
| Rate for Payer: Galaxy Health WC |
$40,989.13
|
| Rate for Payer: Global Benefits Group Commercial |
$28,933.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,621.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,451.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,573.40
|
| Rate for Payer: Multiplan Commercial |
$38,578.01
|
| Rate for Payer: Networks By Design Commercial |
$24,111.26
|
| Rate for Payer: Prime Health Services Commercial |
$40,989.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,097.91
|
| Rate for Payer: United Healthcare All Other HMO |
$17,615.68
|
| Rate for Payer: United Healthcare HMO Rider |
$17,234.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,792.87
|
|
|
AFLIBERCEPT 8 MG/0.07 ML INTRAVITREAL SOLUTION FOR INJECTION [239224]
|
Facility
|
OP
|
$48,222.51
|
|
|
Service Code
|
HCPCS J0177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$298.68 |
| Max. Negotiated Rate |
$40,989.13 |
| Rate for Payer: Adventist Health Commercial |
$9,644.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,020.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$328.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$838.39
|
| Rate for Payer: Blue Shield of California Commercial |
$393.75
|
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Cigna of CA HMO |
$33,755.76
|
| Rate for Payer: Cigna of CA PPO |
$33,755.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$328.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$328.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,755.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.82
|
| Rate for Payer: EPIC Health Plan Senior |
$328.55
|
| Rate for Payer: Galaxy Health WC |
$40,989.13
|
| Rate for Payer: Global Benefits Group Commercial |
$28,933.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$489.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$298.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$298.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,621.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$583.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,573.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$376.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$400.23
|
| Rate for Payer: Multiplan Commercial |
$38,578.01
|
| Rate for Payer: Networks By Design Commercial |
$24,111.26
|
| Rate for Payer: Prime Health Services Commercial |
$40,989.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,933.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,933.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,097.91
|
| Rate for Payer: United Healthcare All Other HMO |
$17,615.68
|
| Rate for Payer: United Healthcare HMO Rider |
$17,234.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,792.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$298.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$328.55
|
| Rate for Payer: Vantage Medical Group Senior |
$328.55
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$99,232.06
|
|
|
Service Code
|
MSDRG 560
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$99,232.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,138.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$99,232.06
|
| Rate for Payer: EPIC Health Plan Senior |
$66,154.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,140.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,196.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80,588.46
|
| 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
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$112,341.97
|
|
|
Service Code
|
MSDRG 559
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$112,341.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,536.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$112,341.97
|
| Rate for Payer: EPIC Health Plan Senior |
$74,894.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,086.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95,320.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91,235.29
|
| 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
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$93,514.69
|
|
|
Service Code
|
MSDRG 561
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$93,514.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,371.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,514.69
|
| Rate for Payer: EPIC Health Plan Senior |
$62,343.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,675.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,345.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75,945.26
|
| 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
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
|
IP
|
$100,360.62
|
|
|
Service Code
|
MSDRG 949
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$100,360.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,066.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$100,360.62
|
| Rate for Payer: EPIC Health Plan Senior |
$66,907.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,824.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85,154.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81,504.99
|
| 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
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
|
IP
|
$90,388.04
|
|
|
Service Code
|
MSDRG 950
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$90,388.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,029.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$90,388.04
|
| Rate for Payer: EPIC Health Plan Senior |
$60,258.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54,780.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76,692.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73,406.04
|
| 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
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION [35775]
|
Facility
|
OP
|
$9,674.75
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.72 |
| Max. Negotiated Rate |
$8,223.54 |
| Rate for Payer: Adventist Health Commercial |
$1,934.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,401.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.03
|
| Rate for Payer: Blue Shield of California Commercial |
$255.55
|
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Cigna of CA HMO |
$6,772.32
|
| Rate for Payer: Cigna of CA PPO |
$6,772.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,772.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.99
|
| Rate for Payer: EPIC Health Plan Senior |
$255.99
|
| Rate for Payer: Galaxy Health WC |
$8,223.54
|
| Rate for Payer: Global Benefits Group Commercial |
$5,804.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$381.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$232.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,143.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$437.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,321.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$293.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$7,739.80
|
| Rate for Payer: Networks By Design Commercial |
$4,837.38
|
| Rate for Payer: Prime Health Services Commercial |
$8,223.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,804.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,804.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,630.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3,534.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3,457.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,168.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$232.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Vantage Medical Group Senior |
$255.99
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION [35775]
|
Facility
|
IP
|
$9,674.75
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,934.95 |
| Max. Negotiated Rate |
$8,223.54 |
| Rate for Payer: Adventist Health Commercial |
$1,934.95
|
| Rate for Payer: Blue Shield of California Commercial |
$4,905.10
|
| Rate for Payer: Blue Shield of California Commercial |
$7,439.88
|
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Cigna of CA HMO |
$6,772.32
|
| Rate for Payer: Cigna of CA PPO |
$6,772.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,772.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,869.90
|
| Rate for Payer: EPIC Health Plan Senior |
$3,869.90
|
| Rate for Payer: Galaxy Health WC |
$8,223.54
|
| Rate for Payer: Global Benefits Group Commercial |
$5,804.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,143.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,708.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,321.94
|
| Rate for Payer: Multiplan Commercial |
$7,739.80
|
| Rate for Payer: Networks By Design Commercial |
$4,837.38
|
| Rate for Payer: Prime Health Services Commercial |
$8,223.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,630.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3,534.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3,457.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,168.48
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION [38494]
|
Facility
|
IP
|
$1,381.87
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$276.37 |
| Max. Negotiated Rate |
$1,174.59 |
| Rate for Payer: Adventist Health Commercial |
$276.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.66
|
| Rate for Payer: Blue Shield of California Commercial |
$700.61
|
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Cigna of CA HMO |
$967.31
|
| Rate for Payer: Cigna of CA PPO |
$967.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$967.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.75
|
| Rate for Payer: EPIC Health Plan Senior |
$552.75
|
| Rate for Payer: Galaxy Health WC |
$1,174.59
|
| Rate for Payer: Global Benefits Group Commercial |
$829.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$877.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$815.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.65
|
| Rate for Payer: Multiplan Commercial |
$1,105.50
|
| Rate for Payer: Networks By Design Commercial |
$690.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,174.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.62
|
| Rate for Payer: United Healthcare All Other HMO |
$504.80
|
| Rate for Payer: United Healthcare HMO Rider |
$493.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.56
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION [38494]
|
Facility
|
OP
|
$1,381.87
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.72 |
| Max. Negotiated Rate |
$1,401.56 |
| Rate for Payer: Adventist Health Commercial |
$276.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,401.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.03
|
| Rate for Payer: Blue Shield of California Commercial |
$255.55
|
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Cigna of CA HMO |
$967.31
|
| Rate for Payer: Cigna of CA PPO |
$967.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$967.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.99
|
| Rate for Payer: EPIC Health Plan Senior |
$255.99
|
| Rate for Payer: Galaxy Health WC |
$1,174.59
|
| Rate for Payer: Global Benefits Group Commercial |
$829.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$381.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$232.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$877.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$437.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$293.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$1,105.50
|
| Rate for Payer: Networks By Design Commercial |
$690.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,174.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$829.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$829.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.62
|
| Rate for Payer: United Healthcare All Other HMO |
$504.80
|
| Rate for Payer: United Healthcare HMO Rider |
$493.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$232.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$290.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.99
|
| Rate for Payer: Vantage Medical Group Senior |
$255.99
|
|
|
AGAR (BULK) 100 % POWDER [40822641]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 9999922641
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
AGAR (BULK) 100 % POWDER [40822641]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 9999922641
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
|
IP
|
$160,208.60
|
|
|
Service Code
|
MSDRG 245
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$160,208.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138,313.72
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160,208.60
|
| Rate for Payer: EPIC Health Plan Senior |
$106,805.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$97,096.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135,934.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130,108.80
|
| 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
|
|
|
AICD LEAD PROCEDURES
|
Facility
|
IP
|
$143,453.92
|
|
|
Service Code
|
MSDRG 265
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$143,453.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109,689.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$143,453.92
|
| Rate for Payer: EPIC Health Plan Senior |
$95,635.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$86,941.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$121,718.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116,501.97
|
| 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
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
OP
|
$35.85
|
|
|
Service Code
|
NDC 7220505108
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$30.47 |
| Rate for Payer: Adventist Health Commercial |
$7.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.00
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cigna of CA HMO |
$25.09
|
| Rate for Payer: Cigna of CA PPO |
$25.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.34
|
| Rate for Payer: EPIC Health Plan Senior |
$14.34
|
| Rate for Payer: Galaxy Health WC |
$30.47
|
| Rate for Payer: Global Benefits Group Commercial |
$21.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.09
|
| Rate for Payer: Multiplan Commercial |
$28.68
|
| Rate for Payer: Networks By Design Commercial |
$23.30
|
| Rate for Payer: Prime Health Services Commercial |
$30.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO |
$17.93
|
| Rate for Payer: United Healthcare HMO Rider |
$17.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.47
|
| Rate for Payer: Vantage Medical Group Senior |
$30.47
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
NDC 3172293502
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$18.25
|
| Rate for Payer: Blue Shield of California Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
