|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT) INCLUDING IMAGE GUIDANCE, IF PERFORMED
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 64561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,161.60 |
| Max. Negotiated Rate |
$28,817.00 |
| 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 |
$14,109.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$13,286.43
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| 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 |
$1,161.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,196.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,283.16
|
| 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
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$52,107.10
|
|
|
Service Code
|
APR-DRG 0303
|
| Min. Negotiated Rate |
$32,909.75 |
| Max. Negotiated Rate |
$52,107.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$32,909.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39,217.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52,107.10
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$71,187.51
|
|
|
Service Code
|
APR-DRG 0304
|
| Min. Negotiated Rate |
$44,960.53 |
| Max. Negotiated Rate |
$71,187.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$44,960.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53,577.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71,187.51
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$25,064.57
|
|
|
Service Code
|
APR-DRG 0301
|
| Min. Negotiated Rate |
$15,830.26 |
| Max. Negotiated Rate |
$25,064.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,830.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,864.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,064.57
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$40,767.20
|
|
|
Service Code
|
APR-DRG 0302
|
| Min. Negotiated Rate |
$25,747.70 |
| Max. Negotiated Rate |
$40,767.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,747.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30,682.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,767.20
|
|
|
PERCUTANEOUS LAMINOTOMY/LAMINECTOMY (INTERLAMINAR APPROACH) FOR DECOMPRESSION OF NEURAL ELEMENTS, (WITH OR WITHOUT LIGAMENTOUS RESECTION, DISCECTOMY, FACETECTOMY AND/OR FORAMINOTOMY), ANY METHOD, UNDER INDIRECT IMAGE GUIDANCE (EG, FLUOROSCOPIC, CT), SINGLE OR MULTIPLE LEVELS, UNILATERAL OR BILATERAL; LUMBAR
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 0275T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,736.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| 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
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; COMPLEX (EG, STONE[S] > 2 CM, BRANCHING STONES, STONES IN MULTIPLE LOCATIONS, URETER STONES, COMPLICATED ANATOMY)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 50081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$217.72 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,175.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,263.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,393.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,175.45
|
| 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 |
$18,720.61
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,263.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,393.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,175.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,089.49
|
| Rate for Payer: EPIC Health Plan Senior |
$13,393.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19,967.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,175.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,045.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,315.10
|
| Rate for Payer: Multiplan WC |
$18,720.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,175.45
|
| Rate for Payer: Preferred Health Network WC |
$19,102.66
|
| Rate for Payer: Prime Health Services Medicare |
$12,905.98
|
| Rate for Payer: Prime Health Services WC |
$18,529.58
|
| Rate for Payer: Riverside University Health System MISP |
$13,393.00
|
| 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 |
$12,175.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,263.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,393.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,175.45
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 26776
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$356.04 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$356.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$393.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 26706
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$306.73 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$306.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$338.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF POSTERIOR PELVIC BONE FRACTURE AND/OR DISLOCATION, FOR FRACTURE PATTERNS THAT DISRUPT THE PELVIC RING, UNILATERAL (INCLUDES IPSILATERAL ILIUM, SACROILIAC JOINT AND/OR SACRUM)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 27216
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$799.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$799.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$883.50
|
| 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
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF POSTERIOR PELVIC BONE FRACTURE AND/OR DISLOCATION, FOR FRACTURE PATTERNS WHICH DISRUPT THE PELVIC RING, UNILATERAL OR BILATERAL, (INCLUDES ILIUM, SACROILIAC JOINT AND/OR SACRUM)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT G0413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| 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 |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| 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) Medicare Advantage |
$9,332.70
|
| 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 |
$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 |
$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
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$111,660.64
|
|
|
Service Code
|
APR-DRG 1834
|
| Min. Negotiated Rate |
$70,522.51 |
| Max. Negotiated Rate |
$111,660.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$70,522.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84,039.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111,660.64
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$64,353.38
|
|
|
Service Code
|
APR-DRG 1832
|
| Min. Negotiated Rate |
$40,644.24 |
| Max. Negotiated Rate |
$64,353.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$40,644.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48,434.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64,353.38
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$60,725.81
|
|
|
Service Code
|
APR-DRG 1831
|
| Min. Negotiated Rate |
$38,353.14 |
| Max. Negotiated Rate |
$60,725.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,353.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45,704.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60,725.81
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$78,676.28
|
|
|
Service Code
|
APR-DRG 1833
|
| Min. Negotiated Rate |
$49,690.28 |
| Max. Negotiated Rate |
$78,676.28 |
| Rate for Payer: Adventist Health Medi-Cal |
$49,690.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59,214.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78,676.28
|
|
|
PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 22515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$335.55 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$335.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$370.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBAR
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 22514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.85 |
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| 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 |
$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 |
$149.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.53
|
| 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
|
|
|
PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; THORACIC
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 22513
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$803.00 |
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| 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 |
$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 |
$803.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$887.03
|
| 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
|
|
|
PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; EACH ADDITIONAL CERVICOTHORACIC OR LUMBOSACRAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 22512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$312.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$312.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$345.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBOSACRAL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 22511
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$636.52 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| 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 |
$6,568.63
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$636.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
PERFLUTREN PROTEIN-TYPE A MICROSPHERES 0.22 MG/ML INTRAVENOUS SUSP [82177]
|
Facility
|
OP
|
$56.16
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$259.54 |
| Rate for Payer: Adventist Health Commercial |
$11.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$259.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.49
|
| Rate for Payer: Blue Shield of California Commercial |
$35.61
|
| Rate for Payer: Blue Shield of California EPN |
$22.41
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Central Health Plan Commercial |
$44.93
|
| Rate for Payer: Cigna of CA HMO |
$39.31
|
| Rate for Payer: Cigna of CA PPO |
$39.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.46
|
| Rate for Payer: EPIC Health Plan Senior |
$22.46
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$42.12
|
| Rate for Payer: Networks By Design Commercial |
$28.08
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
| Rate for Payer: Riverside University Health System MISP |
$22.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.08
|
| Rate for Payer: United Healthcare All Other HMO |
$20.52
|
| Rate for Payer: United Healthcare HMO Rider |
$20.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.74
|
| Rate for Payer: Vantage Medical Group Senior |
$47.74
|
|
|
PERFLUTREN PROTEIN-TYPE A MICROSPHERES 0.22 MG/ML INTRAVENOUS SUSP [82177]
|
Facility
|
IP
|
$56.16
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$50.54 |
| Rate for Payer: Adventist Health Commercial |
$11.23
|
| Rate for Payer: Blue Shield of California Commercial |
$45.04
|
| Rate for Payer: Blue Shield of California EPN |
$28.30
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Central Health Plan Commercial |
$44.93
|
| Rate for Payer: Cigna of CA HMO |
$39.31
|
| Rate for Payer: Cigna of CA PPO |
$39.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.46
|
| Rate for Payer: EPIC Health Plan Senior |
$22.46
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$42.12
|
| Rate for Payer: Networks By Design Commercial |
$28.08
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.08
|
| Rate for Payer: United Healthcare All Other HMO |
$20.52
|
| Rate for Payer: United Healthcare HMO Rider |
$20.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.39
|
|
|
PERI-IMPLANT CAPSULECTOMY, BREAST, COMPLETE, INCLUDING REMOVAL OF ALL INTRACAPSULAR CONTENTS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 19371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$725.53 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,035.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| 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 |
$7,752.28
|
| 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 |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$725.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,050.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| 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 |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 56810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$427.04 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,163.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| 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 |
$6,436.87
|
| 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 |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$427.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$471.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| 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 |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$16,401.54
|
|
|
Service Code
|
APR-DRG 1973
|
| Min. Negotiated Rate |
$10,358.87 |
| Max. Negotiated Rate |
$16,401.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,358.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,344.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,401.54
|
|
