|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 62321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$864.04 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: IEHP medi-cal |
$1,425.67
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Innovage PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health MISP |
$950.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 62323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$864.04 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: IEHP medi-cal |
$1,425.67
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Innovage PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health MISP |
$950.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 62322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,138.83 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: IEHP medi-cal |
$1,879.07
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Innovage PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health MISP |
$1,252.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 0232T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$497.82 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$497.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: IEHP medi-cal |
$821.40
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Innovage PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Riverside University Health MISP |
$547.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 20552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.06 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: IEHP medi-cal |
$610.60
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Innovage PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health MISP |
$407.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
Injection(s); single or multiple trigger point(s), 3 or more muscles
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 20553
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.06 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: IEHP medi-cal |
$610.60
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Innovage PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health MISP |
$407.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
Injection(s); single tendon origin/insertion
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 20551
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.06 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: IEHP medi-cal |
$610.60
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Innovage PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health MISP |
$407.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 20526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.06 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: IEHP medi-cal |
$610.60
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Innovage PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health MISP |
$407.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN [219527]
|
Facility
OP
|
$26,288.27
|
|
|
Service Code
|
NDC 0008-0100-01
|
| Hospital Charge Code |
ERX219527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,257.65 |
| Max. Negotiated Rate |
$23,659.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15,964.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22,345.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,458.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14,458.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,728.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,531.11
|
| Rate for Payer: BCBS Transplant Transplant |
$15,772.96
|
| Rate for Payer: Blue Shield of California Commercial |
$16,535.32
|
| Rate for Payer: Blue Shield of California EPN |
$12,854.96
|
| Rate for Payer: Cash Price |
$11,829.72
|
| Rate for Payer: Cash Price |
$11,829.72
|
| Rate for Payer: Central Health Plan Commercial |
$21,030.62
|
| Rate for Payer: Cigna of CA HMO |
$18,401.79
|
| Rate for Payer: Cigna of CA PPO |
$18,401.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,345.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,515.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,515.31
|
| Rate for Payer: Galaxy Health WC |
$22,345.03
|
| Rate for Payer: Global Benefits Group Commercial |
$15,772.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,659.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19,716.20
|
| Rate for Payer: IEHP medi-cal |
$9,200.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,534.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,257.65
|
| Rate for Payer: Multiplan Commercial |
$19,716.20
|
| Rate for Payer: Networks By Design Commercial |
$13,144.14
|
| Rate for Payer: Prime Health Services Commercial |
$22,345.03
|
| Rate for Payer: Riverside University Health MISP |
$10,515.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,772.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,772.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,144.14
|
| Rate for Payer: United Healthcare All Other HMO |
$13,144.14
|
| Rate for Payer: United Healthcare HMO Rider |
$13,144.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,144.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,345.03
|
| Rate for Payer: Vantage Medical Group Senior |
$22,345.03
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN [219527]
|
Facility
IP
|
$26,288.27
|
|
|
Service Code
|
NDC 0008-0100-01
|
| Hospital Charge Code |
ERX219527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,257.65 |
| Max. Negotiated Rate |
$23,659.44 |
| Rate for Payer: Blue Shield of California Commercial |
$19,716.20
|
| Rate for Payer: Blue Shield of California EPN |
$14,037.94
|
| Rate for Payer: Cash Price |
$11,829.72
|
| Rate for Payer: Central Health Plan Commercial |
$21,030.62
|
| Rate for Payer: Cigna of CA HMO |
$18,401.79
|
| Rate for Payer: Cigna of CA PPO |
$18,401.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,515.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,515.31
|
| Rate for Payer: Galaxy Health WC |
$22,345.03
|
| Rate for Payer: Global Benefits Group Commercial |
$15,772.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,659.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,534.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,257.65
|
| Rate for Payer: Multiplan Commercial |
$19,716.20
|
| Rate for Payer: Networks By Design Commercial |
$13,144.14
|
| Rate for Payer: Prime Health Services Commercial |
$22,345.03
|
|
|
INPATIENT MS-DRG 001: HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC
|
Facility
IP
|
$713,208.05
|
|
|
Service Code
|
MS-DRG 001
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$713,208.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$713,208.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$478,511.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$587,775.01
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$592,983.50
|
| Rate for Payer: BCBS Transplant Transplant |
$242,760.00
|
| Rate for Payer: Blue Shield of California Transplant |
$140,000.00
|
| Rate for Payer: Caremore Medicare Advantage |
$366,357.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$494,582.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$366,357.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$125,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$242,950.00
|
| Rate for Payer: IEHP Medicare Advantage |
$366,357.49
|
| Rate for Payer: Innovage PACE Commercial |
$549,536.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$366,357.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$490,919.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$490,919.04
|
| Rate for Payer: Multiplan WC |
$592,983.50
|
| Rate for Payer: OptumHealth/URN Transplant Commercial |
$149,000.00
|
| Rate for Payer: Preferred Health Network WC |
$605,085.20
|
| Rate for Payer: Prime Health Services Medicare |
$388,338.94
|
| Rate for Payer: Prime Health Services WC |
$572,123.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 002: HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC
|
Facility
IP
|
$322,252.47
|
|
|
Service Code
|
MS-DRG 002
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$322,252.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$322,252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$229,056.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281,358.75
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$283,851.97
|
| Rate for Payer: BCBS Transplant Transplant |
$242,760.00
|
| Rate for Payer: Blue Shield of California Transplant |
$140,000.00
|
| Rate for Payer: Caremore Medicare Advantage |
$166,054.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$224,173.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$166,054.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$125,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$242,950.00
|
| Rate for Payer: IEHP Medicare Advantage |
$166,054.33
|
| Rate for Payer: Innovage PACE Commercial |
$249,081.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166,054.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$222,512.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$222,512.80
|
| Rate for Payer: Multiplan WC |
$283,851.97
|
| Rate for Payer: OptumHealth/URN Transplant Commercial |
$149,000.00
|
| Rate for Payer: Preferred Health Network WC |
$289,644.87
|
| Rate for Payer: Prime Health Services Medicare |
$176,017.59
|
| Rate for Payer: Prime Health Services WC |
$273,866.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 003: ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES
|
Facility
IP
|
$561,128.98
|
|
|
Service Code
|
MS-DRG 003
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$561,128.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$561,128.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344,050.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422,611.36
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$426,356.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$389,395.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$288,440.93
|
| Rate for Payer: IEHP Medicare Advantage |
$288,440.93
|
| Rate for Payer: Innovage PACE Commercial |
$432,661.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$288,440.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386,510.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386,510.85
|
| Rate for Payer: Multiplan WC |
$426,356.27
|
| Rate for Payer: Preferred Health Network WC |
$435,057.42
|
| Rate for Payer: Prime Health Services Medicare |
$305,747.39
|
| Rate for Payer: Prime Health Services WC |
$411,357.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 004: TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
|
Facility
IP
|
$386,889.30
|
|
|
Service Code
|
MS-DRG 004
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$386,889.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$386,889.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233,452.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286,759.09
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$289,300.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$268,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199,170.53
|
| Rate for Payer: IEHP Medicare Advantage |
$199,170.53
|
| Rate for Payer: Innovage PACE Commercial |
$298,755.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199,170.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266,888.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266,888.51
|
| Rate for Payer: Multiplan WC |
$289,300.16
|
| Rate for Payer: Preferred Health Network WC |
$295,204.25
|
| Rate for Payer: Prime Health Services Medicare |
$211,120.76
|
| Rate for Payer: Prime Health Services WC |
$279,123.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 005: LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT
|
Facility
IP
|
$272,401.65
|
|
|
Service Code
|
MS-DRG 005
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$272,401.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$272,401.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$193,930.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238,212.38
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$240,323.26
|
| Rate for Payer: BCBS Transplant Transplant |
$207,570.00
|
| Rate for Payer: Blue Shield of California Transplant |
$160,000.00
|
| Rate for Payer: Caremore Medicare Advantage |
$140,513.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$189,693.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$140,513.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$135,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$129,950.00
|
| Rate for Payer: IEHP Medicare Advantage |
$140,513.63
|
| Rate for Payer: Innovage PACE Commercial |
$210,770.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140,513.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188,288.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188,288.26
|
| Rate for Payer: Multiplan WC |
$240,323.26
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: OptumHealth/URN Transplant Commercial |
$180,500.00
|
| Rate for Payer: Preferred Health Network WC |
$245,227.82
|
| Rate for Payer: Prime Health Services Medicare |
$148,944.45
|
| Rate for Payer: Prime Health Services WC |
$231,869.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 006: LIVER TRANSPLANT WITHOUT MCC
|
Facility
IP
|
$207,570.00
|
|
|
Service Code
|
MS-DRG 006
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$207,570.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127,302.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81,762.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100,432.61
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$101,322.58
|
| Rate for Payer: BCBS Transplant Transplant |
$207,570.00
|
| Rate for Payer: Blue Shield of California Transplant |
$160,000.00
|
| Rate for Payer: Caremore Medicare Advantage |
$66,173.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$89,333.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$66,173.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$135,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$129,950.00
|
| Rate for Payer: IEHP Medicare Advantage |
$66,173.10
|
| Rate for Payer: Innovage PACE Commercial |
$99,259.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66,173.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88,671.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88,671.95
|
| Rate for Payer: Multiplan WC |
$101,322.58
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: OptumHealth/URN Transplant Commercial |
$180,500.00
|
| Rate for Payer: Preferred Health Network WC |
$103,390.39
|
| Rate for Payer: Prime Health Services Medicare |
$70,143.49
|
| Rate for Payer: Prime Health Services WC |
$97,758.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 007: LUNG TRANSPLANT
|
Facility
IP
|
$322,839.38
|
|
|
Service Code
|
MS-DRG 007
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$322,839.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$322,839.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207,536.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254,925.05
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$257,184.03
|
| Rate for Payer: Caremore Medicare Advantage |
$166,355.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$224,579.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$166,355.03
|
| Rate for Payer: IEHP Medicare Advantage |
$166,355.03
|
| Rate for Payer: Innovage PACE Commercial |
$249,532.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166,355.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$222,915.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$222,915.74
|
| Rate for Payer: Multiplan WC |
$257,184.03
|
| Rate for Payer: Preferred Health Network WC |
$262,432.68
|
| Rate for Payer: Prime Health Services Medicare |
$176,336.33
|
| Rate for Payer: Prime Health Services WC |
$248,136.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 008: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
IP
|
$138,482.68
|
|
|
Service Code
|
MS-DRG 008
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$138,482.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138,482.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95,054.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116,758.94
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$117,793.58
|
| Rate for Payer: BCBS Transplant Transplant |
$135,605.00
|
| Rate for Payer: Blue Shield of California Transplant |
$102,000.00
|
| Rate for Payer: Caremore Medicare Advantage |
$71,901.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,066.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$71,901.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90,300.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$96,050.00
|
| Rate for Payer: IEHP Medicare Advantage |
$71,901.24
|
| Rate for Payer: Innovage PACE Commercial |
$107,851.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71,901.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96,347.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96,347.66
|
| Rate for Payer: Multiplan WC |
$117,793.58
|
| Rate for Payer: Networks By Design Commercial |
$85,000.00
|
| Rate for Payer: OptumHealth/URN Transplant Commercial |
$100,600.00
|
| Rate for Payer: Preferred Health Network WC |
$120,197.53
|
| Rate for Payer: Prime Health Services Medicare |
$76,215.31
|
| Rate for Payer: Prime Health Services WC |
$113,649.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 010: PANCREAS TRANSPLANT
|
Facility
IP
|
$126,689.14
|
|
|
Service Code
|
MS-DRG 010
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$126,689.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126,689.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70,499.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86,597.62
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$87,365.00
|
| Rate for Payer: BCBS Transplant Transplant |
$112,995.00
|
| Rate for Payer: Blue Shield of California Transplant |
$95,000.00
|
| Rate for Payer: Caremore Medicare Advantage |
$65,858.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$88,909.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$65,858.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$70,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$77,857.00
|
| Rate for Payer: IEHP Medicare Advantage |
$65,858.92
|
| Rate for Payer: Innovage PACE Commercial |
$98,788.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65,858.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88,250.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88,250.95
|
| Rate for Payer: Multiplan WC |
$87,365.00
|
| Rate for Payer: Networks By Design Commercial |
$60,000.00
|
| Rate for Payer: OptumHealth/URN Transplant Commercial |
$81,000.00
|
| Rate for Payer: Preferred Health Network WC |
$89,147.96
|
| Rate for Payer: Prime Health Services Medicare |
$69,810.46
|
| Rate for Payer: Prime Health Services WC |
$84,291.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 011: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC
|
Facility
IP
|
$135,708.66
|
|
|
Service Code
|
MS-DRG 011
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$135,708.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$135,708.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87,813.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107,864.87
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$108,820.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$95,148.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$70,480.01
|
| Rate for Payer: IEHP Medicare Advantage |
$70,480.01
|
| Rate for Payer: Innovage PACE Commercial |
$105,720.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,480.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94,443.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94,443.21
|
| Rate for Payer: Multiplan WC |
$108,820.70
|
| Rate for Payer: Preferred Health Network WC |
$111,041.53
|
| Rate for Payer: Prime Health Services Medicare |
$74,708.81
|
| Rate for Payer: Prime Health Services WC |
$104,992.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 012: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC
|
Facility
IP
|
$105,404.96
|
|
|
Service Code
|
MS-DRG 012
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$105,404.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105,404.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66,465.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81,642.09
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$82,365.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$74,188.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$54,954.14
|
| Rate for Payer: IEHP Medicare Advantage |
$54,954.14
|
| Rate for Payer: Innovage PACE Commercial |
$82,431.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54,954.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73,638.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73,638.55
|
| Rate for Payer: Multiplan WC |
$82,365.55
|
| Rate for Payer: Preferred Health Network WC |
$84,046.48
|
| Rate for Payer: Prime Health Services Medicare |
$58,251.39
|
| Rate for Payer: Prime Health Services WC |
$79,468.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 013: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC
|
Facility
IP
|
$70,684.94
|
|
|
Service Code
|
MS-DRG 013
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$70,684.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70,684.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48,083.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59,063.39
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$59,586.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,173.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37,165.60
|
| Rate for Payer: IEHP Medicare Advantage |
$37,165.60
|
| Rate for Payer: Innovage PACE Commercial |
$55,748.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,165.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49,801.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49,801.90
|
| Rate for Payer: Multiplan WC |
$59,586.77
|
| Rate for Payer: Preferred Health Network WC |
$60,802.83
|
| Rate for Payer: Prime Health Services Medicare |
$39,395.54
|
| Rate for Payer: Prime Health Services WC |
$57,490.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 014: ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
IP
|
$301,639.43
|
|
|
Service Code
|
MS-DRG 014
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$301,639.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$301,639.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$190,292.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233,743.42
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$235,814.70
|
| Rate for Payer: Caremore Medicare Advantage |
$155,493.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$209,916.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$155,493.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$165,000.00
|
| Rate for Payer: IEHP Medicare Advantage |
$155,493.40
|
| Rate for Payer: Innovage PACE Commercial |
$233,240.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155,493.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208,361.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208,361.16
|
| Rate for Payer: Multiplan WC |
$235,814.70
|
| Rate for Payer: Preferred Health Network WC |
$240,627.25
|
| Rate for Payer: Prime Health Services Medicare |
$164,823.00
|
| Rate for Payer: Prime Health Services WC |
$227,519.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 016: AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
IP
|
$162,572.46
|
|
|
Service Code
|
MS-DRG 016
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$162,572.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$162,572.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103,440.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127,060.53
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$128,186.45
|
| Rate for Payer: Caremore Medicare Advantage |
$84,243.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$113,728.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$84,243.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90,244.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$158,516.00
|
| Rate for Payer: IEHP Medicare Advantage |
$84,243.47
|
| Rate for Payer: Innovage PACE Commercial |
$126,365.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84,243.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112,886.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112,886.25
|
| Rate for Payer: Multiplan WC |
$128,186.45
|
| Rate for Payer: Networks By Design Commercial |
$110,000.00
|
| Rate for Payer: OptumHealth/URN Transplant Commercial |
$120,000.00
|
| Rate for Payer: Preferred Health Network WC |
$130,802.50
|
| Rate for Payer: Prime Health Services Medicare |
$89,298.08
|
| Rate for Payer: Prime Health Services WC |
$123,677.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
