|
CHEMODENERVATION OF ONE EXTREMITY; EACH ADDITIONAL EXTREMITY, 1-4 MUSCLE(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.37 |
| 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 |
$104.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.29
|
| 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
|
|
|
CHEMODENERVATION OF ONE EXTREMITY; EACH ADDITIONAL EXTREMITY, 5 OR MORE MUSCLES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$119.11 |
| 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 |
$119.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.57
|
| 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
|
|
|
CHEMODENERVATION OF PAROTID AND SUBMANDIBULAR SALIVARY GLANDS, BILATERAL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64611
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| 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 |
$597.61
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$147.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
CHEMODENERVATION OF TRUNK MUSCLE(S); 1-5 MUSCLE(S)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 64646
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$169.70 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$907.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| 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 |
$1,402.00
|
| 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 |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$169.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| 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 |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$11,108.25
|
|
|
Service Code
|
APR-DRG 6951
|
| Min. Negotiated Rate |
$7,015.74 |
| Max. Negotiated Rate |
$11,108.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,015.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,360.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,108.25
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$16,073.24
|
|
|
Service Code
|
APR-DRG 6952
|
| Min. Negotiated Rate |
$10,151.52 |
| Max. Negotiated Rate |
$16,073.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,151.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,097.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,073.24
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$74,148.37
|
|
|
Service Code
|
APR-DRG 6954
|
| Min. Negotiated Rate |
$46,830.55 |
| Max. Negotiated Rate |
$74,148.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$46,830.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55,806.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74,148.37
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$31,594.59
|
|
|
Service Code
|
APR-DRG 6953
|
| Min. Negotiated Rate |
$19,954.48 |
| Max. Negotiated Rate |
$31,594.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,954.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,779.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,594.59
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$126,444.37
|
|
|
Service Code
|
MSDRG 837
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$126,444.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126,444.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81,677.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114,351.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$110,818.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73,879.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67,162.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94,027.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89,998.06
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67,162.73
|
| Rate for Payer: Prime Health Services Medicare |
$71,192.49
|
| 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
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
|
IP
|
$54,938.28
|
|
|
Service Code
|
MSDRG 838
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$54,938.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,938.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35,487.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49,684.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,990.33
|
| Rate for Payer: EPIC Health Plan Senior |
$32,660.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,691.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41,567.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39,786.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29,691.11
|
| Rate for Payer: Prime Health Services Medicare |
$31,472.58
|
| 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
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$38,002.00
|
|
|
Service Code
|
MSDRG 839
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$38,002.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38,002.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,547.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,367.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,346.30
|
| Rate for Payer: EPIC Health Plan Senior |
$22,897.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,815.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,142.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,893.36
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,815.94
|
| Rate for Payer: Prime Health Services Medicare |
$22,064.90
|
| 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
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$34,430.52
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$34,430.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,430.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,240.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,137.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,258.18
|
| Rate for Payer: EPIC Health Plan Senior |
$20,838.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,944.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,522.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,385.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18,944.35
|
| Rate for Payer: Prime Health Services Medicare |
$20,081.01
|
| 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
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$68,232.01
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$68,232.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68,232.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44,075.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61,706.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$60,484.84
|
| Rate for Payer: EPIC Health Plan Senior |
$40,323.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,657.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51,320.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49,121.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$36,657.48
|
| Rate for Payer: Prime Health Services Medicare |
$38,856.93
|
| 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
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,355.36
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$22,355.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,355.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,440.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,217.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,817.34
|
| Rate for Payer: EPIC Health Plan Senior |
$13,878.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,616.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,663.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,906.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,616.57
|
| Rate for Payer: Prime Health Services Medicare |
$13,373.56
|
| 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
|
|
|
CHERRY FLAVOR (BULK) ORAL SYRUP [247654]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0395266216
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CHERRY FLAVOR (BULK) ORAL SYRUP [247654]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0395266216
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$7,607.60
|
|
|
Service Code
|
APR-DRG 2031
|
| Min. Negotiated Rate |
$4,804.80 |
| Max. Negotiated Rate |
$7,607.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,804.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,725.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,607.60
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$11,432.55
|
|
|
Service Code
|
APR-DRG 2033
|
| Min. Negotiated Rate |
$7,220.56 |
| Max. Negotiated Rate |
$11,432.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,220.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,604.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,432.55
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$18,004.84
|
|
|
Service Code
|
APR-DRG 2034
|
| Min. Negotiated Rate |
$11,371.48 |
| Max. Negotiated Rate |
$18,004.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,371.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,551.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,004.84
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$9,092.05
|
|
|
Service Code
|
APR-DRG 2032
|
| Min. Negotiated Rate |
$5,742.35 |
| Max. Negotiated Rate |
$9,092.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,742.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,842.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,092.05
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$18,949.68
|
|
|
Service Code
|
MSDRG 313
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$18,949.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,949.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,240.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,137.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,872.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11,915.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,831.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,164.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,514.69
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,831.86
|
| Rate for Payer: Prime Health Services Medicare |
$11,481.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$141,788.91
|
|
|
Service Code
|
APR-DRG 0111
|
| Min. Negotiated Rate |
$89,550.89 |
| Max. Negotiated Rate |
$141,788.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$89,550.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106,714.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141,788.91
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$335,632.53
|
|
|
Service Code
|
APR-DRG 0112
|
| Min. Negotiated Rate |
$211,978.44 |
| Max. Negotiated Rate |
$335,632.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$211,978.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252,607.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$335,632.53
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$508,881.07
|
|
|
Service Code
|
APR-DRG 0114
|
| Min. Negotiated Rate |
$321,398.57 |
| Max. Negotiated Rate |
$508,881.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$321,398.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$382,999.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$508,881.07
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$397,182.16
|
|
|
Service Code
|
APR-DRG 0113
|
| Min. Negotiated Rate |
$250,851.89 |
| Max. Negotiated Rate |
$397,182.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$250,851.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$298,931.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$397,182.16
|
|
