|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$20,596.97
|
|
|
Service Code
|
APR-DRG 0242
|
| Min. Negotiated Rate |
$15,800.04 |
| Max. Negotiated Rate |
$20,596.97 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,800.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,596.97
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$35,992.36
|
|
|
Service Code
|
APR-DRG 0243
|
| Min. Negotiated Rate |
$27,609.93 |
| Max. Negotiated Rate |
$35,992.36 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,609.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,992.36
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$61,244.68
|
|
|
Service Code
|
APR-DRG 0244
|
| Min. Negotiated Rate |
$46,981.11 |
| Max. Negotiated Rate |
$61,244.68 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46,981.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61,244.68
|
|
|
Open implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator
|
Facility
|
OP
|
$63,628.21
|
|
|
Service Code
|
CPT 64568
|
| Min. Negotiated Rate |
$1,044.81 |
| Max. Negotiated Rate |
$63,628.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58,196.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42,677.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38,797.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,713.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58,196.54
|
| Rate for Payer: Dignity Health Media |
$38,797.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,677.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,376.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38,797.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$38,797.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$63,628.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$63,628.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62,852.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$62,852.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,797.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,044.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,797.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,885.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,988.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58,196.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,677.46
|
| Rate for Payer: Vantage Medical Group Senior |
$38,797.69
|
|
|
Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed
|
Facility
|
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 27814
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Open treatment of clavicular fracture, includes internal fixation, when performed
|
Facility
|
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 23515
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of tibia only
|
Facility
|
OP
|
$26,968.11
|
|
|
Service Code
|
CPT 27827
|
| Min. Negotiated Rate |
$343.79 |
| Max. Negotiated Rate |
$26,968.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Media |
$16,443.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,199.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$16,443.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,968.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$26,968.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,639.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$26,639.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,443.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,034.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performed
|
Facility
|
OP
|
$26,968.11
|
|
|
Service Code
|
CPT 24575
|
| Min. Negotiated Rate |
$720.80 |
| Max. Negotiated Rate |
$26,968.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Media |
$16,443.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,199.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$16,443.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,968.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$26,968.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,639.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$26,639.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,443.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,034.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; without intercondylar extension
|
Facility
|
OP
|
$26,968.11
|
|
|
Service Code
|
CPT 24545
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$26,968.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Media |
$16,443.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,199.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$16,443.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,968.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$26,968.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,639.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$26,639.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,443.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,034.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
Open treatment of medial malleolus fracture, includes internal fixation, when performed
|
Facility
|
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 27766
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius AND ulna
|
Facility
|
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 25575
|
| Min. Negotiated Rate |
$961.32 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip
|
Facility
|
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 27822
|
| Min. Negotiated Rate |
$1,492.54 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,492.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 92018
|
| Min. Negotiated Rate |
$90.97 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$903.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,788.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,729.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4,729.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$6,414.61
|
|
|
Service Code
|
APR-DRG 7732
|
| Min. Negotiated Rate |
$4,920.68 |
| Max. Negotiated Rate |
$6,414.61 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,920.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,414.61
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$11,903.46
|
|
|
Service Code
|
APR-DRG 7733
|
| Min. Negotiated Rate |
$9,131.21 |
| Max. Negotiated Rate |
$11,903.46 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,131.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,903.46
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$4,492.17
|
|
|
Service Code
|
APR-DRG 7731
|
| Min. Negotiated Rate |
$3,445.97 |
| Max. Negotiated Rate |
$4,492.17 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,445.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,492.17
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$26,293.32
|
|
|
Service Code
|
APR-DRG 7734
|
| Min. Negotiated Rate |
$20,169.74 |
| Max. Negotiated Rate |
$26,293.32 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,169.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,293.32
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
IP
|
$6.28
|
|
|
Service Code
|
NDC 42799-217-01
|
| Hospital Charge Code |
NDG99405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Blue Shield of California Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
OP
|
$6.28
|
|
|
Service Code
|
NDC 42799-217-01
|
| Hospital Charge Code |
NDG99405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: Blue Distinction Transplant |
$3.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4.63
|
| Rate for Payer: Blue Shield of California EPN |
$3.67
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.34
|
| Rate for Payer: Dignity Health Media |
$5.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Vantage Medical Group Senior |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
IP
|
$6.28
|
|
|
Service Code
|
NDC 9999-9994-05
|
| Hospital Charge Code |
1715201
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Blue Shield of California Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
OP
|
$6.28
|
|
|
Service Code
|
NDC 9999-9994-05
|
| Hospital Charge Code |
1715201
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: Blue Distinction Transplant |
$3.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4.63
|
| Rate for Payer: Blue Shield of California EPN |
$3.67
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.34
|
| Rate for Payer: Dignity Health Media |
$5.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Vantage Medical Group Senior |
$5.34
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$54,510.85
|
|
|
Service Code
|
APR-DRG 0734
|
| Min. Negotiated Rate |
$41,815.56 |
| Max. Negotiated Rate |
$54,510.85 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41,815.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,510.85
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$14,226.69
|
|
|
Service Code
|
APR-DRG 0731
|
| Min. Negotiated Rate |
$10,913.37 |
| Max. Negotiated Rate |
$14,226.69 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,913.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,226.69
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$18,059.14
|
|
|
Service Code
|
APR-DRG 0732
|
| Min. Negotiated Rate |
$13,853.26 |
| Max. Negotiated Rate |
$18,059.14 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,853.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,059.14
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$28,260.09
|
|
|
Service Code
|
APR-DRG 0733
|
| Min. Negotiated Rate |
$21,678.46 |
| Max. Negotiated Rate |
$28,260.09 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21,678.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,260.09
|
|
