|
OPEN TREATMENT OF MANDIBULAR FRACTURE; WITH INTERDENTAL FIXATION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 21462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.12 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$208.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, INCLUDES REPAIR OF TUBEROSITY(S), WHEN PERFORMED;
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 23615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.18 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: EPIC Health Plan Senior |
$18,163.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$16,512.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$26,048.55
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,245.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27,080.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,117.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Preferred Health Network WC |
$26,580.15
|
| Rate for Payer: Prime Health Services Medicare |
$17,503.45
|
| Rate for Payer: Prime Health Services WC |
$25,782.75
|
| Rate for Payer: Riverside University Health System MISP |
$18,163.96
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$16,512.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
OPEN TREATMENT OF SCAPULAR FRACTURE (BODY, GLENOID OR ACROMION) INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 23585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$870.25 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$870.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITHOUT FIXATION OF POSTERIOR LIP
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 27822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,351.15 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,351.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,492.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES]), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 24685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$115.91 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH OR WITHOUT MANIPULATION OF GLOBE FOR PASSIVE RANGE OF MOTION OR OTHER MANIPULATION TO FACILITATE DIAGNOSTIC EXAMINATION; COMPLETE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 92018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$82.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| 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 |
$4,723.01
|
| 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: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$13,058.00
|
|
|
Service Code
|
APR-DRG 7733
|
| Min. Negotiated Rate |
$8,247.16 |
| Max. Negotiated Rate |
$13,058.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,247.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,827.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,058.00
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$7,005.36
|
|
|
Service Code
|
APR-DRG 7732
|
| Min. Negotiated Rate |
$4,424.44 |
| Max. Negotiated Rate |
$7,005.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,424.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,272.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,005.36
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$4,975.06
|
|
|
Service Code
|
APR-DRG 7731
|
| Min. Negotiated Rate |
$3,142.14 |
| Max. Negotiated Rate |
$4,975.06 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,142.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,744.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,975.06
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$28,104.00
|
|
|
Service Code
|
APR-DRG 7734
|
| Min. Negotiated Rate |
$17,749.90 |
| Max. Negotiated Rate |
$28,104.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,749.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,151.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,104.00
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
OP
|
$6.28
|
|
|
Service Code
|
NDC 4279921701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.98
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$4.71
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
| Rate for Payer: Riverside University Health System MISP |
$2.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Vantage Medical Group Senior |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
OP
|
$6.28
|
|
|
Service Code
|
NDC 9999999405
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.98
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$4.71
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
| Rate for Payer: Riverside University Health System MISP |
$2.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Vantage Medical Group Senior |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
IP
|
$6.28
|
|
|
Service Code
|
NDC 4279921701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.71
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
IP
|
$6.28
|
|
|
Service Code
|
NDC 9999999405
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.71
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
|
|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$61,878.60
|
|
|
Service Code
|
MSDRG 113
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$61,878.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61,878.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39,971.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55,960.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,991.32
|
| Rate for Payer: EPIC Health Plan Senior |
$36,660.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,328.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,659.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44,659.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$33,328.07
|
| Rate for Payer: Prime Health Services Medicare |
$35,327.75
|
| 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
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$35,609.61
|
|
|
Service Code
|
MSDRG 114
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$35,609.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,609.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,002.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32,204.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,277.70
|
| Rate for Payer: EPIC Health Plan Senior |
$21,518.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,562.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,387.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,213.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19,562.24
|
| Rate for Payer: Prime Health Services Medicare |
$20,735.97
|
| 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
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$52,894.65
|
|
|
Service Code
|
APR-DRG 0734
|
| Min. Negotiated Rate |
$33,407.15 |
| Max. Negotiated Rate |
$52,894.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$33,407.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39,810.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52,894.65
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$18,611.11
|
|
|
Service Code
|
APR-DRG 0732
|
| Min. Negotiated Rate |
$11,754.38 |
| Max. Negotiated Rate |
$18,611.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,754.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,007.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,611.11
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$13,944.23
|
|
|
Service Code
|
APR-DRG 0731
|
| Min. Negotiated Rate |
$8,806.88 |
| Max. Negotiated Rate |
$13,944.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,806.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,494.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,944.23
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$28,210.74
|
|
|
Service Code
|
APR-DRG 0733
|
| Min. Negotiated Rate |
$17,817.31 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,817.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,232.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,210.74
|
|
|
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF LESION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$912.51 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$912.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,008.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 54530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$580.16 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,604.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,144.49
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,598.23
|
| Rate for Payer: EPIC Health Plan Senior |
$5,065.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,552.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$580.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,446.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Preferred Health Network WC |
$7,290.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,881.29
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Riverside University Health System MISP |
$5,065.49
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,604.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$42,344.64
|
|
|
Service Code
|
MSDRG 884
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$42,344.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,344.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,352.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38,295.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,101.19
|
| Rate for Payer: EPIC Health Plan Senior |
$25,400.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,091.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,328.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,942.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,091.63
|
| Rate for Payer: Prime Health Services Medicare |
$24,477.13
|
| 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
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$15,392.43
|
|
|
Service Code
|
APR-DRG 7573
|
| Min. Negotiated Rate |
$9,721.54 |
| Max. Negotiated Rate |
$15,392.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,721.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,584.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,392.43
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$7,019.45
|
|
|
Service Code
|
APR-DRG 7571
|
| Min. Negotiated Rate |
$4,433.34 |
| Max. Negotiated Rate |
$7,019.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,433.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,283.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,019.45
|
|
