|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$183,030.46
|
|
|
Service Code
|
APR-DRG 1664
|
| Min. Negotiated Rate |
$146,183.54 |
| Max. Negotiated Rate |
$183,030.46 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146,183.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183,030.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163,764.09
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$84,807.77
|
|
|
Service Code
|
APR-DRG 1662
|
| Min. Negotiated Rate |
$67,734.63 |
| Max. Negotiated Rate |
$84,807.77 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67,734.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84,807.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75,880.64
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$183,386.89
|
|
|
Service Code
|
MSDRG 235
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$183,386.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$177,912.48
|
| 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 |
$183,386.89
|
| Rate for Payer: EPIC Health Plan Senior |
$122,257.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111,143.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155,601.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148,932.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$83,791.00
|
| Rate for Payer: United Healthcare All Other HMO |
$83,791.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56,388.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51,660.00
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$153,579.13
|
|
|
Service Code
|
MSDRG 236
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$153,579.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126,987.66
|
| 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 |
$153,579.13
|
| Rate for Payer: EPIC Health Plan Senior |
$102,386.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$93,078.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130,309.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124,724.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$76,448.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76,448.00
|
| Rate for Payer: United Healthcare HMO Rider |
$52,096.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47,726.00
|
|
|
CORONARY BYPASS WITH PTCA WITH MCC
|
Facility
|
IP
|
$255,560.85
|
|
|
Service Code
|
MSDRG 231
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$255,560.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$255,560.85
|
| 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 |
$228,836.73
|
| Rate for Payer: EPIC Health Plan Senior |
$152,557.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$138,688.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$194,164.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185,843.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$107,429.00
|
| Rate for Payer: United Healthcare All Other HMO |
$107,429.00
|
| Rate for Payer: United Healthcare HMO Rider |
$94,080.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86,191.00
|
|
|
CORONARY BYPASS WITH PTCA WITHOUT MCC
|
Facility
|
IP
|
$186,829.40
|
|
|
Service Code
|
MSDRG 232
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$186,829.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$183,793.78
|
| 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 |
$186,829.40
|
| Rate for Payer: EPIC Health Plan Senior |
$124,552.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113,229.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158,521.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151,728.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$94,061.00
|
| Rate for Payer: United Healthcare All Other HMO |
$94,061.00
|
| Rate for Payer: United Healthcare HMO Rider |
$79,841.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,147.00
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$156,038.57
|
|
|
Service Code
|
MSDRG 323
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$156,038.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$131,189.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$156,038.57
|
| Rate for Payer: EPIC Health Plan Senior |
$104,025.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94,568.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132,396.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126,722.23
|
| 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
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$135,163.56
|
|
|
Service Code
|
MSDRG 324
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$135,163.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$95,525.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$135,163.56
|
| Rate for Payer: EPIC Health Plan Senior |
$90,109.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$81,917.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114,684.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109,769.20
|
| 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
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$136,217.61
|
|
|
Service Code
|
MSDRG 325
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$136,217.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97,326.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$136,217.61
|
| Rate for Payer: EPIC Health Plan Senior |
$90,811.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$82,556.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115,578.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110,625.21
|
| 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
|
|
|
CORRECTION OF TRICHIASIS; EPILATION BY OTHER THAN FORCEPS (EG, BY ELECTROSURGERY, CRYOTHERAPY, LASER SURGERY)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 67825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.70 |
| 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 |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| 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 |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$262.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$571.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$514.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.04
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| 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 |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
|
OP
|
$8,168.16
|
|
|
Service Code
|
HCPCS J0801
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,633.63 |
| Max. Negotiated Rate |
$24,487.59 |
| Rate for Payer: Adventist Health Commercial |
$1,633.63
|
| Rate for Payer: Adventist Health Commercial |
$2,239.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,487.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,487.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,546.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,546.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,133.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,133.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,910.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,910.03
|
| Rate for Payer: Blue Shield of California Commercial |
$5,278.05
|
| Rate for Payer: Blue Shield of California Commercial |
$5,278.05
|
| Rate for Payer: Cash Price |
$5,039.60
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cash Price |
$5,039.60
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cigna of CA HMO |
$5,717.71
|
| Rate for Payer: Cigna of CA HMO |
$7,839.38
|
| Rate for Payer: Cigna of CA PPO |
$5,717.71
|
| Rate for Payer: Cigna of CA PPO |
$7,839.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,546.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,546.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,133.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,839.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,717.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,820.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,820.19
|
| Rate for Payer: EPIC Health Plan Senior |
$4,546.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,546.80
|
| Rate for Payer: Galaxy Health WC |
$9,519.25
|
| Rate for Payer: Galaxy Health WC |
$6,942.94
|
| Rate for Payer: Global Benefits Group Commercial |
$6,719.47
|
| Rate for Payer: Global Benefits Group Commercial |
$4,900.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,778.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,778.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,133.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,133.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,133.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,133.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,111.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,186.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,936.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,936.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,786.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,786.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,960.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,687.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,208.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,208.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,538.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,538.82
|
| Rate for Payer: Multiplan Commercial |
$8,959.30
|
| Rate for Payer: Multiplan Commercial |
$6,534.53
|
| Rate for Payer: Networks By Design Commercial |
$4,084.08
|
| Rate for Payer: Networks By Design Commercial |
$5,599.56
|
| Rate for Payer: Prime Health Services Commercial |
$9,519.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,942.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,900.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,719.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,719.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,900.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,065.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.03
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.04
|
| Rate for Payer: United Healthcare All Other HMO |
$2,983.83
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2,919.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,675.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,667.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,133.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,133.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,546.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,546.80
|
| Rate for Payer: Vantage Medical Group Senior |
$4,133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,133.45
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
|
IP
|
$8,168.16
|
|
|
Service Code
|
HCPCS J0801
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,633.63 |
| Max. Negotiated Rate |
$6,942.94 |
| Rate for Payer: Multiplan Commercial |
$6,534.53
|
| Rate for Payer: Networks By Design Commercial |
$4,084.08
|
| Rate for Payer: Networks By Design Commercial |
$5,599.56
|
| Rate for Payer: Adventist Health Commercial |
$1,633.63
|
| Rate for Payer: Adventist Health Commercial |
$2,239.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8,612.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4,141.26
|
| Rate for Payer: Blue Shield of California Commercial |
$6,281.32
|
| Rate for Payer: Blue Shield of California Commercial |
$5,677.95
|
| Rate for Payer: Cash Price |
$5,039.60
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cigna of CA HMO |
$5,717.71
|
| Rate for Payer: Cigna of CA HMO |
$7,839.38
|
| Rate for Payer: Cigna of CA PPO |
$7,839.38
|
| Rate for Payer: Cigna of CA PPO |
$5,717.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,839.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,717.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,479.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,267.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4,479.65
|
| Rate for Payer: EPIC Health Plan Senior |
$3,267.26
|
| Rate for Payer: Galaxy Health WC |
$9,519.25
|
| Rate for Payer: Galaxy Health WC |
$6,942.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4,900.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,719.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,111.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,186.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,607.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,819.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,687.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,960.36
|
| Rate for Payer: Multiplan Commercial |
$8,959.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,942.94
|
| Rate for Payer: Prime Health Services Commercial |
$9,519.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,065.51
|
| Rate for Payer: United Healthcare All Other HMO |
$2,983.83
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.04
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2,919.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,667.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,675.07
|
|
|
COSIBELIMAB-IPDL 300 MG/5 ML (60 MG/ML) INTRAVENOUS SOLUTION [247041]
|
Facility
|
OP
|
$778.50
|
|
|
Service Code
|
HCPCS J9275
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$661.73 |
| Rate for Payer: Adventist Health Commercial |
$155.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.31
|
| Rate for Payer: Cash Price |
$350.32
|
| Rate for Payer: Cash Price |
$350.32
|
| Rate for Payer: Cigna of CA HMO |
$544.95
|
| Rate for Payer: Cigna of CA PPO |
$544.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.75
|
| Rate for Payer: EPIC Health Plan Senior |
$24.50
|
| Rate for Payer: Galaxy Health WC |
$661.73
|
| Rate for Payer: Global Benefits Group Commercial |
$467.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$282.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$622.80
|
| Rate for Payer: Networks By Design Commercial |
$389.25
|
| Rate for Payer: Prime Health Services Commercial |
$661.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$467.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$467.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.17
|
| Rate for Payer: United Healthcare All Other HMO |
$284.39
|
| Rate for Payer: United Healthcare HMO Rider |
$278.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.50
|
| Rate for Payer: Vantage Medical Group Senior |
$22.27
|
|
|
COSIBELIMAB-IPDL 300 MG/5 ML (60 MG/ML) INTRAVENOUS SOLUTION [247041]
|
Facility
|
IP
|
$778.50
|
|
|
Service Code
|
HCPCS J9275
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.70 |
| Max. Negotiated Rate |
$661.73 |
| Rate for Payer: Adventist Health Commercial |
$155.70
|
| Rate for Payer: Blue Shield of California Commercial |
$394.70
|
| Rate for Payer: Blue Shield of California Commercial |
$598.67
|
| Rate for Payer: Cash Price |
$350.32
|
| Rate for Payer: Cigna of CA HMO |
$544.95
|
| Rate for Payer: Cigna of CA PPO |
$544.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.40
|
| Rate for Payer: EPIC Health Plan Senior |
$311.40
|
| Rate for Payer: Galaxy Health WC |
$661.73
|
| Rate for Payer: Global Benefits Group Commercial |
$467.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.84
|
| Rate for Payer: Multiplan Commercial |
$622.80
|
| Rate for Payer: Networks By Design Commercial |
$389.25
|
| Rate for Payer: Prime Health Services Commercial |
$661.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.17
|
| Rate for Payer: United Healthcare All Other HMO |
$284.39
|
| Rate for Payer: United Healthcare HMO Rider |
$278.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.96
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
|
IP
|
$96.24
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$81.80 |
| Rate for Payer: Adventist Health Commercial |
$19.25
|
| Rate for Payer: Blue Shield of California Commercial |
$48.79
|
| Rate for Payer: Blue Shield of California Commercial |
$74.01
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Senior |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: Multiplan Commercial |
$76.99
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.12
|
| Rate for Payer: United Healthcare All Other HMO |
$35.16
|
| Rate for Payer: United Healthcare HMO Rider |
$34.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.52
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
|
OP
|
$96.24
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$272.23 |
| Rate for Payer: Adventist Health Commercial |
$19.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.23
|
| Rate for Payer: Blue Shield of California Commercial |
$96.24
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Senior |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.37
|
| Rate for Payer: Multiplan Commercial |
$76.99
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.12
|
| Rate for Payer: United Healthcare All Other HMO |
$35.16
|
| Rate for Payer: United Healthcare HMO Rider |
$34.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.80
|
| Rate for Payer: Vantage Medical Group Senior |
$81.80
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$107,717.63
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$107,717.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,635.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$107,717.63
|
| Rate for Payer: EPIC Health Plan Senior |
$71,811.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,283.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91,396.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,479.77
|
| 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
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$97,540.99
|
|
|
Service Code
|
MSDRG 074
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$97,540.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,249.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,540.99
|
| Rate for Payer: EPIC Health Plan Senior |
$65,027.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,115.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,762.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,215.10
|
| 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
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$134,421.82
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$134,421.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$94,258.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$134,421.82
|
| Rate for Payer: EPIC Health Plan Senior |
$89,614.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$81,467.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114,054.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109,166.81
|
| 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
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$159,930.03
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$159,930.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$137,837.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$159,930.03
|
| Rate for Payer: EPIC Health Plan Senior |
$106,620.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$96,927.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135,698.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$129,882.57
|
| 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
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$124,018.04
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$124,018.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76,484.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$124,018.04
|
| Rate for Payer: EPIC Health Plan Senior |
$82,678.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75,162.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105,227.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100,717.68
|
| 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
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$86,561.62
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$69,135.40 |
| Max. Negotiated Rate |
$86,561.62 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69,135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86,561.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77,449.88
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$189,487.95
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$151,341.03 |
| Max. Negotiated Rate |
$189,487.95 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$151,341.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189,487.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169,541.85
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$57,956.10
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$46,288.62 |
| Max. Negotiated Rate |
$57,956.10 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46,288.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57,956.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,855.46
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$204,060.03
|
|
|
Service Code
|
MSDRG 955
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$204,060.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$204,060.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$198,691.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132,461.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$120,419.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$168,586.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161,361.82
|
| 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
|
|
