|
EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); LESS THAN 2 CM
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 21013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$696.14 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$696.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$787.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 27632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.46 |
| 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 |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$114.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$129.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| 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 |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 21552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$621.72 |
| 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 |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$621.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| 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 |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 21554
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$203.28 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$203.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| 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 |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 27327
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 27339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.65 |
| 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 |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$207.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| 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 |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
OP
|
$13.03
|
|
|
Service Code
|
NDC 0054008013
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.36
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$10.42
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6.51
|
| Rate for Payer: United Healthcare HMO Rider |
$6.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
IP
|
$48.35
|
|
|
Service Code
|
NDC 0009766304
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Adventist Health Commercial |
$9.67
|
| Rate for Payer: Blue Shield of California Commercial |
$24.51
|
| Rate for Payer: Blue Shield of California Commercial |
$37.18
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Cigna of CA HMO |
$33.84
|
| Rate for Payer: Cigna of CA PPO |
$33.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.34
|
| Rate for Payer: EPIC Health Plan Senior |
$19.34
|
| Rate for Payer: Galaxy Health WC |
$41.10
|
| Rate for Payer: Global Benefits Group Commercial |
$29.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$38.68
|
| Rate for Payer: Networks By Design Commercial |
$31.43
|
| Rate for Payer: Prime Health Services Commercial |
$41.10
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
IP
|
$13.03
|
|
|
Service Code
|
NDC 0054008013
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$10.02
|
| Rate for Payer: Blue Shield of California Commercial |
$6.61
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.42
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
OP
|
$48.35
|
|
|
Service Code
|
NDC 0009766304
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Adventist Health Commercial |
$9.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.03
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Cigna of CA HMO |
$33.84
|
| Rate for Payer: Cigna of CA PPO |
$33.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.34
|
| Rate for Payer: EPIC Health Plan Senior |
$19.34
|
| Rate for Payer: Galaxy Health WC |
$41.10
|
| Rate for Payer: Global Benefits Group Commercial |
$29.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$38.68
|
| Rate for Payer: Networks By Design Commercial |
$31.43
|
| Rate for Payer: Prime Health Services Commercial |
$41.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.18
|
| Rate for Payer: United Healthcare All Other HMO |
$24.18
|
| Rate for Payer: United Healthcare HMO Rider |
$24.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.10
|
| Rate for Payer: Vantage Medical Group Senior |
$41.10
|
|
|
EXPLORATION NOT FOLLOWED BY SURGICAL REPAIR, ARTERY; UPPER EXTREMITY (EG, AXILLARY, BRACHIAL, RADIAL, ULNAR)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 35702
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$589.81 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$589.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$667.05
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
|
|
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTREMITY
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 20103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$181,937.75
|
|
|
Service Code
|
APR-DRG 9114
|
| Min. Negotiated Rate |
$145,310.81 |
| Max. Negotiated Rate |
$181,937.75 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145,310.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$181,937.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162,786.41
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$39,881.87
|
|
|
Service Code
|
APR-DRG 9111
|
| Min. Negotiated Rate |
$31,853.02 |
| Max. Negotiated Rate |
$39,881.87 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31,853.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39,881.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,683.78
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$75,005.22
|
|
|
Service Code
|
APR-DRG 9113
|
| Min. Negotiated Rate |
$59,905.48 |
| Max. Negotiated Rate |
$75,005.22 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59,905.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75,005.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67,109.93
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$48,417.30
|
|
|
Service Code
|
APR-DRG 9112
|
| Min. Negotiated Rate |
$38,670.13 |
| Max. Negotiated Rate |
$48,417.30 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38,670.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48,417.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,320.74
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$148,351.52
|
|
|
Service Code
|
MSDRG 933
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$148,351.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$115,707.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$148,351.52
|
| Rate for Payer: EPIC Health Plan Senior |
$98,901.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$89,910.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125,874.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120,479.41
|
| 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
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT
|
Facility
|
IP
|
$558,729.94
|
|
|
Service Code
|
MSDRG 927
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$558,729.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$558,729.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$458,110.52
|
| Rate for Payer: EPIC Health Plan Senior |
$305,407.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277,642.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388,699.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372,041.27
|
| 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
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$128,836.15
|
|
|
Service Code
|
APR-DRG 7924
|
| Min. Negotiated Rate |
$102,899.40 |
| Max. Negotiated Rate |
$128,836.15 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102,899.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128,836.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$115,274.45
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$57,583.58
|
|
|
Service Code
|
APR-DRG 7923
|
| Min. Negotiated Rate |
$45,991.10 |
| Max. Negotiated Rate |
$57,583.58 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45,991.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57,583.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,522.15
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$39,267.34
|
|
|
Service Code
|
APR-DRG 7922
|
| Min. Negotiated Rate |
$31,362.20 |
| Max. Negotiated Rate |
$39,267.34 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31,362.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39,267.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,133.93
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$30,824.37
|
|
|
Service Code
|
APR-DRG 7921
|
| Min. Negotiated Rate |
$24,618.93 |
| Max. Negotiated Rate |
$30,824.37 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24,618.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30,824.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,579.69
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$122,875.25
|
|
|
Service Code
|
MSDRG 982
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$122,875.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$74,531.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$122,875.25
|
| Rate for Payer: EPIC Health Plan Senior |
$81,916.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74,469.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104,257.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99,789.60
|
| 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
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$162,504.79
|
|
|
Service Code
|
MSDRG 981
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$162,504.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$142,236.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$162,504.79
|
| Rate for Payer: EPIC Health Plan Senior |
$108,336.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$98,487.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137,882.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131,973.58
|
| 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
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$109,664.25
|
|
|
Service Code
|
MSDRG 983
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$109,664.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51,961.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$109,664.25
|
| Rate for Payer: EPIC Health Plan Senior |
$73,109.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,463.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93,048.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89,060.66
|
| 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
|
|
