|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
|
OP
|
$21.69
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$279.67 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.26
|
| Rate for Payer: Blue Shield of California Commercial |
$111.88
|
| Rate for Payer: Blue Shield of California EPN |
$101.71
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Central Health Plan Commercial |
$17.35
|
| Rate for Payer: Cigna of CA HMO |
$15.18
|
| Rate for Payer: Cigna of CA PPO |
$15.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.34
|
| Rate for Payer: EPIC Health Plan Senior |
$54.23
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$80.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$66.06
|
| Rate for Payer: Multiplan Commercial |
$16.27
|
| Rate for Payer: Networks By Design Commercial |
$10.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Prime Health Services Medicare |
$52.26
|
| Rate for Payer: Riverside University Health System MISP |
$54.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.14
|
| Rate for Payer: United Healthcare All Other HMO |
$7.92
|
| Rate for Payer: United Healthcare HMO Rider |
$7.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.23
|
| Rate for Payer: Vantage Medical Group Senior |
$54.23
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
|
IP
|
$21.69
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$19.52 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Blue Shield of California Commercial |
$17.40
|
| Rate for Payer: Blue Shield of California EPN |
$10.93
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Central Health Plan Commercial |
$17.35
|
| Rate for Payer: Cigna of CA HMO |
$15.18
|
| Rate for Payer: Cigna of CA PPO |
$15.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Senior |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$16.27
|
| Rate for Payer: Networks By Design Commercial |
$10.85
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.14
|
| Rate for Payer: United Healthcare All Other HMO |
$7.92
|
| Rate for Payer: United Healthcare HMO Rider |
$7.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.10
|
|
|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION [210304]
|
Facility
|
OP
|
$2,772.36
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$2,495.12 |
| Rate for Payer: Adventist Health Commercial |
$554.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$80.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$502.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.56
|
| Rate for Payer: Blue Shield of California Commercial |
$148.02
|
| Rate for Payer: Blue Shield of California EPN |
$134.56
|
| Rate for Payer: Cash Price |
$1,247.56
|
| Rate for Payer: Cash Price |
$1,247.56
|
| Rate for Payer: Central Health Plan Commercial |
$2,217.89
|
| Rate for Payer: Cigna of CA HMO |
$1,940.65
|
| Rate for Payer: Cigna of CA PPO |
$1,940.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,940.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.58
|
| Rate for Payer: EPIC Health Plan Senior |
$89.06
|
| Rate for Payer: Galaxy Health WC |
$2,356.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,495.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$132.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,760.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$108.49
|
| Rate for Payer: Multiplan Commercial |
$2,079.27
|
| Rate for Payer: Networks By Design Commercial |
$1,386.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$80.96
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.51
|
| Rate for Payer: Prime Health Services Medicare |
$85.82
|
| Rate for Payer: Riverside University Health System MISP |
$89.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,663.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,663.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,040.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.74
|
| Rate for Payer: United Healthcare HMO Rider |
$990.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$80.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.06
|
| Rate for Payer: Vantage Medical Group Senior |
$89.06
|
|
|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION [210304]
|
Facility
|
IP
|
$2,772.36
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$554.47 |
| Max. Negotiated Rate |
$2,495.12 |
| Rate for Payer: Adventist Health Commercial |
$554.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,223.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,397.27
|
| Rate for Payer: Cash Price |
$1,247.56
|
| Rate for Payer: Central Health Plan Commercial |
$2,217.89
|
| Rate for Payer: Cigna of CA HMO |
$1,940.65
|
| Rate for Payer: Cigna of CA PPO |
$1,940.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,940.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.94
|
| Rate for Payer: EPIC Health Plan Senior |
$1,108.94
|
| Rate for Payer: Galaxy Health WC |
$2,356.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,495.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,760.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,635.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.47
|
| Rate for Payer: Multiplan Commercial |
$2,079.27
|
| Rate for Payer: Networks By Design Commercial |
$1,386.18
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,040.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.74
|
| Rate for Payer: United Healthcare HMO Rider |
$990.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.95
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [207352]
|
Facility
|
OP
|
$23.31
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$297.83 |
| Rate for Payer: Adventist Health Commercial |
$4.66
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$297.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.78
|
| Rate for Payer: Blue Shield of California Commercial |
$128.21
|
| Rate for Payer: Blue Shield of California EPN |
$116.55
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Central Health Plan Commercial |
$18.65
|
| Rate for Payer: Cigna of CA HMO |
$16.32
|
| Rate for Payer: Cigna of CA PPO |
$16.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.65
|
| Rate for Payer: EPIC Health Plan Senior |
$51.77
|
| Rate for Payer: Galaxy Health WC |
$19.81
|
| Rate for Payer: Global Benefits Group Commercial |
$13.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.06
|
| Rate for Payer: Multiplan Commercial |
$17.48
|
| Rate for Payer: Networks By Design Commercial |
$11.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47.06
|
| Rate for Payer: Prime Health Services Commercial |
$19.81
|
| Rate for Payer: Prime Health Services Medicare |
$49.88
|
| Rate for Payer: Riverside University Health System MISP |
$51.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.75
|
| Rate for Payer: United Healthcare All Other HMO |
$8.52
|
| Rate for Payer: United Healthcare HMO Rider |
$8.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.77
|
| Rate for Payer: Vantage Medical Group Senior |
$51.77
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [207352]
|
Facility
|
IP
|
$23.31
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$20.98 |
| Rate for Payer: Adventist Health Commercial |
$4.66
|
| Rate for Payer: Blue Shield of California Commercial |
$18.69
|
| Rate for Payer: Blue Shield of California EPN |
$11.75
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Central Health Plan Commercial |
$18.65
|
| Rate for Payer: Cigna of CA HMO |
$16.32
|
| Rate for Payer: Cigna of CA PPO |
$16.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.32
|
| Rate for Payer: EPIC Health Plan Senior |
$9.32
|
| Rate for Payer: Galaxy Health WC |
$19.81
|
| Rate for Payer: Global Benefits Group Commercial |
$13.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$17.48
|
| Rate for Payer: Networks By Design Commercial |
$11.65
|
| Rate for Payer: Prime Health Services Commercial |
$19.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.75
|
| Rate for Payer: United Healthcare All Other HMO |
$8.52
|
| Rate for Payer: United Healthcare HMO Rider |
$8.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.63
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
|
IP
|
$23.71
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Blue Shield of California Commercial |
$19.02
|
| Rate for Payer: Blue Shield of California EPN |
$11.95
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Central Health Plan Commercial |
$18.97
|
| Rate for Payer: Cigna of CA HMO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$16.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: Networks By Design Commercial |
$11.86
|
| Rate for Payer: Prime Health Services Commercial |
$20.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other HMO |
$8.66
|
| Rate for Payer: United Healthcare HMO Rider |
$8.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.77
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
|
OP
|
$23.71
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$304.76 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$304.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.25
|
| Rate for Payer: Blue Shield of California Commercial |
$119.48
|
| Rate for Payer: Blue Shield of California EPN |
$108.62
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Central Health Plan Commercial |
$18.97
|
| Rate for Payer: Cigna of CA HMO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$16.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.51
|
| Rate for Payer: EPIC Health Plan Senior |
$56.34
|
| Rate for Payer: Galaxy Health WC |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.63
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: Networks By Design Commercial |
$11.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.22
|
| Rate for Payer: Prime Health Services Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Medicare |
$54.29
|
| Rate for Payer: Riverside University Health System MISP |
$56.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other HMO |
$8.66
|
| Rate for Payer: United Healthcare HMO Rider |
$8.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.34
|
| Rate for Payer: Vantage Medical Group Senior |
$56.34
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [210297]
|
Facility
|
IP
|
$11.66
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$10.49 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California Commercial |
$9.35
|
| Rate for Payer: Blue Shield of California EPN |
$5.88
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Central Health Plan Commercial |
$9.33
|
| Rate for Payer: Cigna of CA HMO |
$8.16
|
| Rate for Payer: Cigna of CA PPO |
$8.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Senior |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.91
|
| Rate for Payer: Global Benefits Group Commercial |
$7.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$8.74
|
| Rate for Payer: Networks By Design Commercial |
$5.83
|
| Rate for Payer: Prime Health Services Commercial |
$9.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.26
|
| Rate for Payer: United Healthcare HMO Rider |
$4.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.82
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [210297]
|
Facility
|
OP
|
$11.66
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$297.83 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$297.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.78
|
| Rate for Payer: Blue Shield of California Commercial |
$128.21
|
| Rate for Payer: Blue Shield of California EPN |
$116.55
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Central Health Plan Commercial |
$9.33
|
| Rate for Payer: Cigna of CA HMO |
$8.16
|
| Rate for Payer: Cigna of CA PPO |
$8.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.65
|
| Rate for Payer: EPIC Health Plan Senior |
$51.77
|
| Rate for Payer: Galaxy Health WC |
$9.91
|
| Rate for Payer: Global Benefits Group Commercial |
$7.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.06
|
| Rate for Payer: Multiplan Commercial |
$8.74
|
| Rate for Payer: Networks By Design Commercial |
$5.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47.06
|
| Rate for Payer: Prime Health Services Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Medicare |
$49.88
|
| Rate for Payer: Riverside University Health System MISP |
$51.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.26
|
| Rate for Payer: United Healthcare HMO Rider |
$4.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.77
|
| Rate for Payer: Vantage Medical Group Senior |
$51.77
|
|
|
IMMUNE GLOBU G 5 GRAM/50 ML(10 %)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107752]
|
Facility
|
IP
|
$18.38
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Blue Shield of California Commercial |
$14.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.26
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$12.87
|
| Rate for Payer: Cigna of CA PPO |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$9.19
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.90
|
| Rate for Payer: United Healthcare All Other HMO |
$6.71
|
| Rate for Payer: United Healthcare HMO Rider |
$6.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.02
|
|
|
IMMUNE GLOBU G 5 GRAM/50 ML(10 %)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107752]
|
Facility
|
OP
|
$18.38
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$299.61 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.25
|
| Rate for Payer: Blue Shield of California Commercial |
$93.56
|
| Rate for Payer: Blue Shield of California EPN |
$85.05
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$12.87
|
| Rate for Payer: Cigna of CA PPO |
$12.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.87
|
| Rate for Payer: EPIC Health Plan Senior |
$53.91
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$80.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65.67
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$9.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.01
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Medicare |
$51.95
|
| Rate for Payer: Riverside University Health System MISP |
$53.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.90
|
| Rate for Payer: United Healthcare All Other HMO |
$6.71
|
| Rate for Payer: United Healthcare HMO Rider |
$6.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.91
|
| Rate for Payer: Vantage Medical Group Senior |
$53.91
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$309,204.35
|
|
|
Service Code
|
APR-DRG 1613
|
| Min. Negotiated Rate |
$195,286.96 |
| Max. Negotiated Rate |
$309,204.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$195,286.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232,716.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309,204.35
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$208,984.31
|
|
|
Service Code
|
APR-DRG 1611
|
| Min. Negotiated Rate |
$131,990.09 |
| Max. Negotiated Rate |
$208,984.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$131,990.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$157,288.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208,984.31
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$208,984.31
|
|
|
Service Code
|
APR-DRG 1612
|
| Min. Negotiated Rate |
$131,990.09 |
| Max. Negotiated Rate |
$208,984.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$131,990.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$157,288.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208,984.31
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$384,259.12
|
|
|
Service Code
|
APR-DRG 1614
|
| Min. Negotiated Rate |
$242,689.97 |
| Max. Negotiated Rate |
$384,259.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$242,689.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289,205.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384,259.12
|
|
|
IMPLANTATION OF BIOLOGIC IMPLANT (EG, ACELLULAR DERMAL MATRIX) FOR SOFT TISSUE REINFORCEMENT (IE, BREAST, TRUNK) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$298.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$329.63
|
| 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
|
|
|
IMPLANTATION OF NON-BIOLOGIC OR SYNTHETIC IMPLANT (EG, POLYPROPYLENE) FOR FASCIAL REINFORCEMENT OF THE ABDOMINAL WALL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 0437T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABLE PUMP, INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT PROGRAMMING
|
Facility
|
OP
|
$71,375.00
|
|
|
Service Code
|
CPT 62362
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$89.65 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,181.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,772.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,499.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,181.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$35,780.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,772.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,499.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,181.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,249.79
|
| Rate for Payer: EPIC Health Plan Senior |
$25,499.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,017.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,181.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,454.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,063.46
|
| Rate for Payer: Multiplan WC |
$35,780.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,181.69
|
| Rate for Payer: Preferred Health Network WC |
$36,511.02
|
| Rate for Payer: Prime Health Services Medicare |
$24,572.59
|
| Rate for Payer: Prime Health Services WC |
$35,415.69
|
| Rate for Payer: Riverside University Health System MISP |
$25,499.86
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,181.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,772.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,499.86
|
| Rate for Payer: Vantage Medical Group Senior |
$23,181.69
|
|
|
IMPLANTATION, OSSEOINTEGRATED IMPLANT, SKULL; WITH MAGNETIC TRANSCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR, WITHIN THE MASTOID AND/OR RESULTING IN REMOVAL OF LESS THAN 100 SQ MM SURFACE AREA OF BONE DEEP TO THE OUTER CRANIAL CORTEX
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 69716
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$170.97 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,512.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$26,048.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,245.94
|
| Rate for Payer: EPIC Health Plan Senior |
$18,163.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27,080.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,117.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Preferred Health Network WC |
$26,580.15
|
| Rate for Payer: Prime Health Services Medicare |
$17,503.45
|
| Rate for Payer: Prime Health Services WC |
$25,782.75
|
| Rate for Payer: Riverside University Health System MISP |
$18,163.96
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$16,512.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATHETER, FOR LONG-TERM MEDICATION ADMINISTRATION VIA AN EXTERNAL PUMP OR IMPLANTABLE RESERVOIR/INFUSION PUMP; WITHOUT LAMINECTOMY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 62350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$448.89 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,287.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,287.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,964.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,415.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,287.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,623.90
|
| Rate for Payer: EPIC Health Plan Senior |
$12,415.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18,511.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$448.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$495.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,802.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,124.86
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Preferred Health Network WC |
$13,229.47
|
| Rate for Payer: Prime Health Services Medicare |
$11,964.44
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Riverside University Health System MISP |
$12,415.93
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$11,287.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11,287.21
|
|
|
INBORN AND OTHER DISORDERS OF METABOLISM
|
Facility
|
IP
|
$37,428.25
|
|
|
Service Code
|
MSDRG 642
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$37,428.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,428.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,177.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,848.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,850.20
|
| Rate for Payer: EPIC Health Plan Senior |
$22,566.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,515.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,721.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,490.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,515.27
|
| Rate for Payer: Prime Health Services Medicare |
$21,746.19
|
| 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
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$46,648.65
|
|
|
Service Code
|
APR-DRG 4234
|
| Min. Negotiated Rate |
$29,462.30 |
| Max. Negotiated Rate |
$46,648.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$29,462.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35,109.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46,648.65
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$12,077.08
|
|
|
Service Code
|
APR-DRG 4232
|
| Min. Negotiated Rate |
$7,627.63 |
| Max. Negotiated Rate |
$12,077.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,627.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,089.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,077.08
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$8,795.97
|
|
|
Service Code
|
APR-DRG 4231
|
| Min. Negotiated Rate |
$5,555.35 |
| Max. Negotiated Rate |
$8,795.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,555.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,620.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,795.97
|
|
