|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$123,286.96
|
|
|
Service Code
|
MSDRG 545
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$123,286.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75,235.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$123,286.96
|
| Rate for Payer: EPIC Health Plan Senior |
$82,191.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74,719.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104,607.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100,123.96
|
| 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
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$94,087.83
|
|
|
Service Code
|
MSDRG 547
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$94,087.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,350.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$94,087.83
|
| Rate for Payer: EPIC Health Plan Senior |
$62,725.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,022.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,832.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,410.73
|
| 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
|
|
|
CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY;
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 67880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.49 |
| 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 |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,852.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,097.51
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| 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 |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 30901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$91.95 |
| 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 |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); SIMPLE
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 42960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$124.47 |
| 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 |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$971.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$51,236.96
|
|
|
Service Code
|
APR-DRG 3844
|
| Min. Negotiated Rate |
$40,922.15 |
| Max. Negotiated Rate |
$51,236.96 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40,922.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51,236.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,843.59
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$12,146.47
|
|
|
Service Code
|
APR-DRG 3841
|
| Min. Negotiated Rate |
$9,701.20 |
| Max. Negotiated Rate |
$12,146.47 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,701.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,146.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,867.90
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$22,903.46
|
|
|
Service Code
|
APR-DRG 3843
|
| Min. Negotiated Rate |
$18,292.63 |
| Max. Negotiated Rate |
$22,903.46 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18,292.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,903.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,492.56
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$15,749.35
|
|
|
Service Code
|
APR-DRG 3842
|
| Min. Negotiated Rate |
$12,578.75 |
| Max. Negotiated Rate |
$15,749.35 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,578.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,749.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,091.52
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION [219718]
|
Facility
|
OP
|
$6,304.32
|
|
|
Service Code
|
HCPCS J9057
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.07 |
| Max. Negotiated Rate |
$5,358.67 |
| Rate for Payer: Adventist Health Commercial |
$1,260.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$170.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,358.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,467.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,728.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.74
|
| Rate for Payer: Blue Shield of California Commercial |
$105.07
|
| Rate for Payer: Cash Price |
$2,836.94
|
| Rate for Payer: Cash Price |
$2,836.94
|
| Rate for Payer: Cigna of CA HMO |
$4,413.02
|
| Rate for Payer: Cigna of CA PPO |
$4,413.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,358.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,358.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,358.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,413.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,521.73
|
| Rate for Payer: EPIC Health Plan Senior |
$2,521.73
|
| Rate for Payer: Galaxy Health WC |
$5,358.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3,782.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,003.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,288.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,719.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,513.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,413.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,413.02
|
| Rate for Payer: Multiplan Commercial |
$5,043.46
|
| Rate for Payer: Networks By Design Commercial |
$3,152.16
|
| Rate for Payer: Prime Health Services Commercial |
$5,358.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,782.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,782.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,366.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2,302.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,253.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,064.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,358.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,358.67
|
| Rate for Payer: Vantage Medical Group Senior |
$5,358.67
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION [219718]
|
Facility
|
IP
|
$6,304.32
|
|
|
Service Code
|
HCPCS J9057
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,260.86 |
| Max. Negotiated Rate |
$5,358.67 |
| Rate for Payer: Adventist Health Commercial |
$1,260.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3,196.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,848.02
|
| Rate for Payer: Cash Price |
$2,836.94
|
| Rate for Payer: Cigna of CA HMO |
$4,413.02
|
| Rate for Payer: Cigna of CA PPO |
$4,413.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,413.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,521.73
|
| Rate for Payer: EPIC Health Plan Senior |
$2,521.73
|
| Rate for Payer: Galaxy Health WC |
$5,358.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3,782.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,003.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,719.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,513.04
|
| Rate for Payer: Multiplan Commercial |
$5,043.46
|
| Rate for Payer: Networks By Design Commercial |
$3,152.16
|
| Rate for Payer: Prime Health Services Commercial |
$5,358.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,366.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2,302.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,253.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,064.66
|
|
|
COPPER 2 MG (AS GLUCONATE) TABLET [112194]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0536143901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
COPPER 2 MG (AS GLUCONATE) TABLET [112194]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0536143901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
COPPER CHLORIDE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080425]
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.95
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
COPPER CHLORIDE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080425]
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
|
|
COPPER SULFATE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080426]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 9994080426
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
COPPER SULFATE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080426]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 9994080426
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$90,311.35
|
|
|
Service Code
|
APR-DRG 1651
|
| Min. Negotiated Rate |
$72,130.25 |
| Max. Negotiated Rate |
$90,311.35 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72,130.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90,311.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80,804.89
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$98,922.91
|
|
|
Service Code
|
APR-DRG 1652
|
| Min. Negotiated Rate |
$79,008.17 |
| Max. Negotiated Rate |
$98,922.91 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79,008.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98,922.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88,509.97
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$120,379.78
|
|
|
Service Code
|
APR-DRG 1653
|
| Min. Negotiated Rate |
$96,145.43 |
| Max. Negotiated Rate |
$120,379.78 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96,145.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120,379.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107,708.23
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$211,666.19
|
|
|
Service Code
|
APR-DRG 1654
|
| Min. Negotiated Rate |
$169,054.45 |
| Max. Negotiated Rate |
$211,666.19 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169,054.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211,666.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189,385.54
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC
|
Facility
|
IP
|
$231,771.88
|
|
|
Service Code
|
MSDRG 233
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$231,771.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$231,771.88
|
| 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 |
$214,912.35
|
| Rate for Payer: EPIC Health Plan Senior |
$143,274.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130,249.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182,349.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174,534.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$143,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$143,136.00
|
| Rate for Payer: United Healthcare HMO Rider |
$80,682.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,919.00
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC
|
Facility
|
IP
|
$176,184.28
|
|
|
Service Code
|
MSDRG 234
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$176,184.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$165,607.21
|
| 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 |
$176,184.28
|
| Rate for Payer: EPIC Health Plan Senior |
$117,456.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106,778.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149,489.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143,082.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$103,054.00
|
| Rate for Payer: United Healthcare All Other HMO |
$103,054.00
|
| Rate for Payer: United Healthcare HMO Rider |
$74,111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67,897.00
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$76,356.63
|
|
|
Service Code
|
APR-DRG 1661
|
| Min. Negotiated Rate |
$60,984.83 |
| Max. Negotiated Rate |
$76,356.63 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60,984.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76,356.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68,319.09
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$102,501.31
|
|
|
Service Code
|
APR-DRG 1663
|
| Min. Negotiated Rate |
$81,866.18 |
| Max. Negotiated Rate |
$102,501.31 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81,866.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102,501.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91,711.70
|
|
