|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$17,120.62
|
|
|
Service Code
|
APR-DRG 2453
|
| Min. Negotiated Rate |
$10,813.02 |
| Max. Negotiated Rate |
$17,120.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,813.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,885.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,120.62
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$11,772.93
|
|
|
Service Code
|
APR-DRG 2452
|
| Min. Negotiated Rate |
$7,435.54 |
| Max. Negotiated Rate |
$11,772.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,435.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,860.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,772.93
|
|
|
INFLAMMATORY BOWEL DISEASE WITH CC
|
Facility
|
IP
|
$25,695.24
|
|
|
Service Code
|
MSDRG 386
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$25,695.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,695.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,598.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,237.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,705.17
|
| Rate for Payer: EPIC Health Plan Senior |
$15,803.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,366.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,113.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,251.47
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,366.77
|
| Rate for Payer: Prime Health Services Medicare |
$15,228.78
|
| 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
|
|
|
INFLAMMATORY BOWEL DISEASE WITH MCC
|
Facility
|
IP
|
$41,644.55
|
|
|
Service Code
|
MSDRG 385
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$41,644.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,644.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,900.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,661.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,495.87
|
| Rate for Payer: EPIC Health Plan Senior |
$24,997.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,724.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,814.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,451.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,724.77
|
| Rate for Payer: Prime Health Services Medicare |
$24,088.26
|
| 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
|
|
|
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$17,931.13
|
|
|
Service Code
|
MSDRG 387
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$17,931.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,931.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,582.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,216.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,991.90
|
| Rate for Payer: EPIC Health Plan Senior |
$11,327.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,298.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,417.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,799.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,298.12
|
| Rate for Payer: Prime Health Services Medicare |
$10,916.01
|
| 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
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Blue Shield of California Commercial |
$457.14
|
| Rate for Payer: Blue Shield of California EPN |
$287.28
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.48 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.79
|
| Rate for Payer: Blue Shield of California Commercial |
$62.70
|
| Rate for Payer: Blue Shield of California EPN |
$57.00
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.94
|
| Rate for Payer: EPIC Health Plan Senior |
$34.63
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.18
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.48
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Prime Health Services Medicare |
$33.37
|
| Rate for Payer: Riverside University Health System MISP |
$34.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.63
|
| Rate for Payer: Vantage Medical Group Senior |
$34.63
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
|
OP
|
$904.07
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$813.66 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$149.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.01
|
| Rate for Payer: Blue Shield of California Commercial |
$99.45
|
| Rate for Payer: Blue Shield of California EPN |
$90.41
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Central Health Plan Commercial |
$723.26
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$632.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.92
|
| Rate for Payer: EPIC Health Plan Senior |
$29.28
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$574.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.67
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.62
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: Prime Health Services Medicare |
$28.22
|
| Rate for Payer: Riverside University Health System MISP |
$29.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.30
|
| Rate for Payer: United Healthcare All Other HMO |
$330.26
|
| Rate for Payer: United Healthcare HMO Rider |
$323.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
|
IP
|
$904.07
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$813.66 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Blue Shield of California Commercial |
$725.06
|
| Rate for Payer: Blue Shield of California EPN |
$455.65
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Central Health Plan Commercial |
$723.26
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$632.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Senior |
$361.63
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$574.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$533.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.81
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.30
|
| Rate for Payer: United Healthcare All Other HMO |
$330.26
|
| Rate for Payer: United Healthcare HMO Rider |
$323.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.08
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [216056]
|
Facility
|
IP
|
$1,135.54
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.11 |
| Max. Negotiated Rate |
$1,021.99 |
| Rate for Payer: Adventist Health Commercial |
$227.11
|
| Rate for Payer: Blue Shield of California Commercial |
$910.70
|
| Rate for Payer: Blue Shield of California EPN |
$572.31
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Central Health Plan Commercial |
$908.43
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$794.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$794.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.22
|
| Rate for Payer: EPIC Health Plan Senior |
$454.22
|
| Rate for Payer: Galaxy Health WC |
$965.21
|
| Rate for Payer: Global Benefits Group Commercial |
$681.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,021.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$669.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.11
|
| Rate for Payer: Multiplan Commercial |
$851.65
|
| Rate for Payer: Networks By Design Commercial |
$567.77
|
| Rate for Payer: Prime Health Services Commercial |
$965.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$426.17
|
| Rate for Payer: United Healthcare All Other HMO |
$414.81
|
| Rate for Payer: United Healthcare HMO Rider |
$405.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.89
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [216056]
|
Facility
|
OP
|
$1,135.54
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$1,021.99 |
| Rate for Payer: Adventist Health Commercial |
$227.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.71
|
| Rate for Payer: Blue Shield of California Commercial |
$124.91
|
| Rate for Payer: Blue Shield of California EPN |
$113.55
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Central Health Plan Commercial |
$908.43
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$794.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$794.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.72
|
| Rate for Payer: EPIC Health Plan Senior |
$30.48
|
| Rate for Payer: Galaxy Health WC |
$965.21
|
| Rate for Payer: Global Benefits Group Commercial |
$681.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,021.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$45.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.13
|
| Rate for Payer: Multiplan Commercial |
$851.65
|
| Rate for Payer: Networks By Design Commercial |
$567.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.71
|
| Rate for Payer: Prime Health Services Commercial |
$965.21
|
| Rate for Payer: Prime Health Services Medicare |
$29.37
|
| Rate for Payer: Riverside University Health System MISP |
$30.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$681.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$681.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$426.17
|
| Rate for Payer: United Healthcare All Other HMO |
$414.81
|
| Rate for Payer: United Healthcare HMO Rider |
$405.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.48
|
| Rate for Payer: Vantage Medical Group Senior |
$30.48
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC
|
Facility
|
IP
|
$40,123.32
|
|
|
Service Code
|
MSDRG 351
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$40,123.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,123.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,918.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,286.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,180.49
|
| Rate for Payer: EPIC Health Plan Senior |
$24,120.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,927.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,698.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,382.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,927.57
|
| Rate for Payer: Prime Health Services Medicare |
$23,243.22
|
| 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
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC
|
Facility
|
IP
|
$65,584.32
|
|
|
Service Code
|
MSDRG 350
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$65,584.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65,584.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42,364.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59,312.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,195.53
|
| Rate for Payer: EPIC Health Plan Senior |
$38,797.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35,270.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49,378.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47,261.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35,270.02
|
| Rate for Payer: Prime Health Services Medicare |
$37,386.22
|
| 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
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,735.33
|
|
|
Service Code
|
MSDRG 352
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$30,735.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,735.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,853.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,795.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,063.12
|
| Rate for Payer: EPIC Health Plan Senior |
$18,708.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,007.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,811.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,790.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,007.95
|
| Rate for Payer: Prime Health Services Medicare |
$18,028.43
|
| 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
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$18,782.32
|
|
|
Service Code
|
APR-DRG 2282
|
| Min. Negotiated Rate |
$11,862.52 |
| Max. Negotiated Rate |
$18,782.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,862.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,136.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,782.32
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$25,842.05
|
|
|
Service Code
|
APR-DRG 2283
|
| Min. Negotiated Rate |
$16,321.30 |
| Max. Negotiated Rate |
$25,842.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,321.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,449.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,842.05
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$14,733.80
|
|
|
Service Code
|
APR-DRG 2281
|
| Min. Negotiated Rate |
$9,305.56 |
| Max. Negotiated Rate |
$14,733.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,305.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,089.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,733.80
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$45,631.48
|
|
|
Service Code
|
APR-DRG 2284
|
| Min. Negotiated Rate |
$28,819.88 |
| Max. Negotiated Rate |
$45,631.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$28,819.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34,343.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45,631.48
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC INITIAL DAY
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.40 |
| Max. Negotiated Rate |
$2,562.30 |
| Rate for Payer: Adventist Health Commercial |
$569.40
|
| Rate for Payer: Cash Price |
$1,281.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,277.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,992.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,138.80
|
| Rate for Payer: Galaxy Health WC |
$2,419.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,708.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,562.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,807.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,679.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.40
|
| Rate for Payer: Multiplan Commercial |
$2,135.25
|
| Rate for Payer: Networks By Design Commercial |
$1,850.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,419.95
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC INITIAL DAY
|
Facility
|
OP
|
$2,847.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.03 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$569.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,281.15
|
| Rate for Payer: Cash Price |
$1,281.15
|
| Rate for Payer: Cash Price |
$1,281.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,277.60
|
| Rate for Payer: Cigna of CA HMO |
$1,822.08
|
| Rate for Payer: Cigna of CA PPO |
$2,106.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,992.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$2,419.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,708.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,562.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$137.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,807.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,135.25
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,850.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,419.95
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,708.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,423.50
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC SUB DAY
|
Facility
|
IP
|
$2,998.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$599.60 |
| Max. Negotiated Rate |
$2,698.20 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,398.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,098.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,199.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,199.20
|
| Rate for Payer: Galaxy Health WC |
$2,548.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,698.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,903.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,768.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.60
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC SUB DAY
|
Facility
|
OP
|
$2,998.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,398.40
|
| Rate for Payer: Cigna of CA HMO |
$1,918.72
|
| Rate for Payer: Cigna of CA PPO |
$2,218.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,098.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$2,548.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,698.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,903.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,798.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,499.00
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| 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 |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
INJECTION, ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); AIR OR LIQUID
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 66020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$145.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,968.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,155.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
INJECTION, ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); MEDICATION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 66030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$98.61 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,968.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,155.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
