|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$10,421.42
|
|
|
Service Code
|
APR-DRG 2411
|
| Min. Negotiated Rate |
$6,581.95 |
| Max. Negotiated Rate |
$10,421.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,581.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,843.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,421.42
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 7220522130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.42
|
| Rate for Payer: Blue Shield of California EPN |
$4.03
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Central Health Plan Commercial |
$6.40
|
| Rate for Payer: Cigna of CA HMO |
$5.60
|
| Rate for Payer: Cigna of CA PPO |
$5.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3.20
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 6961627230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Blue Shield of California Commercial |
$19.92
|
| Rate for Payer: Blue Shield of California EPN |
$12.52
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Central Health Plan Commercial |
$19.87
|
| Rate for Payer: Cigna of CA HMO |
$17.39
|
| Rate for Payer: Cigna of CA PPO |
$17.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9.94
|
| Rate for Payer: Galaxy Health WC |
$21.11
|
| Rate for Payer: Global Benefits Group Commercial |
$14.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$18.63
|
| Rate for Payer: Networks By Design Commercial |
$16.15
|
| Rate for Payer: Prime Health Services Commercial |
$21.11
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
OP
|
$21.46
|
|
|
Service Code
|
NDC 0480706256
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.48
|
| Rate for Payer: Blue Shield of California Commercial |
$13.61
|
| Rate for Payer: Blue Shield of California EPN |
$8.56
|
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: Central Health Plan Commercial |
$17.17
|
| Rate for Payer: Cigna of CA HMO |
$15.02
|
| Rate for Payer: Cigna of CA PPO |
$15.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.58
|
| Rate for Payer: EPIC Health Plan Senior |
$8.58
|
| Rate for Payer: Galaxy Health WC |
$18.24
|
| Rate for Payer: Global Benefits Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.02
|
| Rate for Payer: Multiplan Commercial |
$16.09
|
| Rate for Payer: Networks By Design Commercial |
$13.95
|
| Rate for Payer: Prime Health Services Commercial |
$18.24
|
| Rate for Payer: Riverside University Health System MISP |
$8.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.24
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 6961627230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.91
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Central Health Plan Commercial |
$19.87
|
| Rate for Payer: Cigna of CA HMO |
$17.39
|
| Rate for Payer: Cigna of CA PPO |
$17.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9.94
|
| Rate for Payer: Galaxy Health WC |
$21.11
|
| Rate for Payer: Global Benefits Group Commercial |
$14.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$18.63
|
| Rate for Payer: Networks By Design Commercial |
$16.15
|
| Rate for Payer: Prime Health Services Commercial |
$21.11
|
| Rate for Payer: Riverside University Health System MISP |
$9.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.42
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.11
|
| Rate for Payer: Vantage Medical Group Senior |
$21.11
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 7220522130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Central Health Plan Commercial |
$6.40
|
| Rate for Payer: Cigna of CA HMO |
$5.60
|
| Rate for Payer: Cigna of CA PPO |
$5.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3.20
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
| Rate for Payer: Riverside University Health System MISP |
$3.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6.80
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
IP
|
$21.46
|
|
|
Service Code
|
NDC 0480706256
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$17.21
|
| Rate for Payer: Blue Shield of California EPN |
$10.82
|
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: Central Health Plan Commercial |
$17.17
|
| Rate for Payer: Cigna of CA HMO |
$15.02
|
| Rate for Payer: Cigna of CA PPO |
$15.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.58
|
| Rate for Payer: EPIC Health Plan Senior |
$8.58
|
| Rate for Payer: Galaxy Health WC |
$18.24
|
| Rate for Payer: Global Benefits Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$16.09
|
| Rate for Payer: Networks By Design Commercial |
$13.95
|
| Rate for Payer: Prime Health Services Commercial |
$18.24
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$108,579.03
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$108,579.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108,579.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70,137.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98,195.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$95,371.15
|
| Rate for Payer: EPIC Health Plan Senior |
$63,580.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,800.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80,920.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77,452.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$57,800.70
|
| Rate for Payer: Prime Health Services Medicare |
$61,268.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$62,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$62,136.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36,699.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33,623.00
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$86,634.25
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$86,634.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$86,634.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55,962.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78,349.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$76,396.45
|
| Rate for Payer: EPIC Health Plan Senior |
$50,930.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46,300.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64,821.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62,043.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$46,300.88
|
| Rate for Payer: Prime Health Services Medicare |
$49,078.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,353.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42,353.00
|
| Rate for Payer: United Healthcare HMO Rider |
$25,015.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,918.00
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$30,464.62
|
|
|
Service Code
|
APR-DRG 1741
|
| Min. Negotiated Rate |
$19,240.81 |
| Max. Negotiated Rate |
$30,464.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,240.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,928.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30,464.62
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$38,809.42
|
|
|
Service Code
|
APR-DRG 1742
|
| Min. Negotiated Rate |
$24,511.21 |
| Max. Negotiated Rate |
$38,809.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$24,511.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29,209.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38,809.42
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$43,877.12
|
|
|
Service Code
|
APR-DRG 1743
|
| Min. Negotiated Rate |
$27,711.86 |
| Max. Negotiated Rate |
$43,877.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,711.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33,023.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43,877.12
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$61,821.54
|
|
|
Service Code
|
APR-DRG 1744
|
| Min. Negotiated Rate |
$39,045.18 |
| Max. Negotiated Rate |
$61,821.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$39,045.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46,528.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61,821.54
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$48,149.21
|
|
|
Service Code
|
APR-DRG 1753
|
| Min. Negotiated Rate |
$30,410.03 |
| Max. Negotiated Rate |
$48,149.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$30,410.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,238.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48,149.21
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$41,166.01
|
|
|
Service Code
|
APR-DRG 1752
|
| Min. Negotiated Rate |
$25,999.58 |
| Max. Negotiated Rate |
$41,166.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,999.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30,982.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41,166.01
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$31,600.63
|
|
|
Service Code
|
APR-DRG 1751
|
| Min. Negotiated Rate |
$19,958.29 |
| Max. Negotiated Rate |
$31,600.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,958.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,783.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,600.63
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$68,508.64
|
|
|
Service Code
|
APR-DRG 1754
|
| Min. Negotiated Rate |
$43,268.62 |
| Max. Negotiated Rate |
$68,508.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$43,268.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51,561.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68,508.64
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
|
IP
|
$71,608.74
|
|
|
Service Code
|
MSDRG 321
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$71,608.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71,608.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46,256.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64,760.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$63,404.53
|
| Rate for Payer: EPIC Health Plan Senior |
$42,269.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,426.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53,797.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51,492.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38,426.99
|
| Rate for Payer: Prime Health Services Medicare |
$40,732.61
|
| 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
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$46,400.40
|
|
|
Service Code
|
MSDRG 322
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$46,400.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,400.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,972.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,962.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,608.02
|
| Rate for Payer: EPIC Health Plan Senior |
$27,738.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,216.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,303.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,790.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,216.98
|
| Rate for Payer: Prime Health Services Medicare |
$26,730.00
|
| 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
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$57,441.22
|
|
|
Service Code
|
MSDRG 250
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$57,441.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,441.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37,104.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51,947.86
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,154.52
|
| Rate for Payer: EPIC Health Plan Senior |
$34,103.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,002.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43,403.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41,543.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31,002.74
|
| Rate for Payer: Prime Health Services Medicare |
$32,862.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$32,556.00
|
| Rate for Payer: United Healthcare All Other HMO |
$32,556.00
|
| Rate for Payer: United Healthcare HMO Rider |
$27,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24,796.00
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$41,406.00
|
|
|
Service Code
|
MSDRG 251
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$41,406.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,333.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,407.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,572.09
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,497.80
|
| Rate for Payer: EPIC Health Plan Senior |
$23,665.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,513.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,119.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,828.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,513.82
|
| Rate for Payer: Prime Health Services Medicare |
$22,804.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,406.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41,406.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22,531.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20,641.00
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$90,500.51
|
|
|
Service Code
|
MSDRG 359
|
| Min. Negotiated Rate |
$48,326.93 |
| Max. Negotiated Rate |
$90,500.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90,500.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58,459.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81,845.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$79,739.43
|
| Rate for Payer: EPIC Health Plan Senior |
$53,159.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48,326.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67,657.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64,758.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48,326.93
|
| Rate for Payer: Prime Health Services Medicare |
$51,226.55
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$63,541.96
|
|
|
Service Code
|
MSDRG 360
|
| Min. Negotiated Rate |
$34,199.73 |
| Max. Negotiated Rate |
$63,541.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63,541.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41,045.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57,465.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$56,429.55
|
| Rate for Payer: EPIC Health Plan Senior |
$37,619.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,199.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47,879.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,827.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$34,199.73
|
| Rate for Payer: Prime Health Services Medicare |
$36,251.71
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$63,749.88
|
|
|
Service Code
|
MSDRG 318
|
| Min. Negotiated Rate |
$34,308.69 |
| Max. Negotiated Rate |
$63,749.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63,749.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41,179.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57,653.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$56,609.34
|
| Rate for Payer: EPIC Health Plan Senior |
$37,739.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,308.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48,032.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,973.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$34,308.69
|
| Rate for Payer: Prime Health Services Medicare |
$36,367.21
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
|
Facility
|
OP
|
$34,476.00
|
|
|
Service Code
|
CPT 63650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$750.50 |
| Max. Negotiated Rate |
$34,476.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,196.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,295.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,016.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,196.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,476.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$13,286.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,295.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,016.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,196.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,524.62
|
| Rate for Payer: EPIC Health Plan Senior |
$9,016.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,442.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$750.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,196.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$829.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,475.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,983.63
|
| Rate for Payer: Multiplan WC |
$13,286.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8,196.74
|
| Rate for Payer: Preferred Health Network WC |
$13,557.58
|
| Rate for Payer: Prime Health Services Medicare |
$8,688.54
|
| Rate for Payer: Prime Health Services WC |
$13,150.85
|
| Rate for Payer: Riverside University Health System MISP |
$9,016.41
|
| 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 |
$8,196.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,295.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,016.41
|
| Rate for Payer: Vantage Medical Group Senior |
$8,196.74
|
|
