|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 0527213335
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.50
|
| Rate for Payer: Cigna of CA PPO |
$3.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Riverside University Health System MISP |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
OP
|
$38.12
|
|
|
Service Code
|
HCPCS J1837
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Adventist Health Commercial |
$7.24
|
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$22.96
|
| Rate for Payer: Blue Shield of California Commercial |
$12.30
|
| Rate for Payer: Blue Shield of California Commercial |
$24.17
|
| Rate for Payer: Blue Shield of California EPN |
$14.45
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Blue Shield of California EPN |
$15.21
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Central Health Plan Commercial |
$28.97
|
| Rate for Payer: Central Health Plan Commercial |
$15.52
|
| Rate for Payer: Central Health Plan Commercial |
$30.50
|
| Rate for Payer: Cigna of CA HMO |
$25.35
|
| Rate for Payer: Cigna of CA HMO |
$26.68
|
| Rate for Payer: Cigna of CA HMO |
$13.58
|
| Rate for Payer: Cigna of CA PPO |
$13.58
|
| Rate for Payer: Cigna of CA PPO |
$25.35
|
| Rate for Payer: Cigna of CA PPO |
$26.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$32.40
|
| Rate for Payer: Galaxy Health WC |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$30.78
|
| Rate for Payer: Global Benefits Group Commercial |
$11.64
|
| Rate for Payer: Global Benefits Group Commercial |
$21.73
|
| Rate for Payer: Global Benefits Group Commercial |
$22.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$27.16
|
| Rate for Payer: Multiplan Commercial |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$28.59
|
| Rate for Payer: Networks By Design Commercial |
$9.70
|
| Rate for Payer: Networks By Design Commercial |
$19.06
|
| Rate for Payer: Networks By Design Commercial |
$18.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.34
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.34
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$16.49
|
| Rate for Payer: Prime Health Services Commercial |
$32.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.78
|
| Rate for Payer: Prime Health Services Medicare |
$0.36
|
| Rate for Payer: Prime Health Services Medicare |
$0.36
|
| Rate for Payer: Prime Health Services Medicare |
$0.36
|
| Rate for Payer: Riverside University Health System MISP |
$0.37
|
| Rate for Payer: Riverside University Health System MISP |
$0.37
|
| Rate for Payer: Riverside University Health System MISP |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.59
|
| Rate for Payer: United Healthcare All Other HMO |
$13.23
|
| Rate for Payer: United Healthcare All Other HMO |
$13.93
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare HMO Rider |
$6.93
|
| Rate for Payer: United Healthcare HMO Rider |
$13.62
|
| Rate for Payer: United Healthcare HMO Rider |
$12.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
IP
|
$38.12
|
|
|
Service Code
|
HCPCS J1837
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Adventist Health Commercial |
$7.24
|
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Blue Shield of California Commercial |
$30.57
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15.56
|
| Rate for Payer: Blue Shield of California EPN |
$9.78
|
| Rate for Payer: Blue Shield of California EPN |
$19.21
|
| Rate for Payer: Blue Shield of California EPN |
$18.25
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: Central Health Plan Commercial |
$28.97
|
| Rate for Payer: Central Health Plan Commercial |
$15.52
|
| Rate for Payer: Central Health Plan Commercial |
$30.50
|
| Rate for Payer: Cigna of CA HMO |
$26.68
|
| Rate for Payer: Cigna of CA HMO |
$13.58
|
| Rate for Payer: Cigna of CA HMO |
$25.35
|
| Rate for Payer: Cigna of CA PPO |
$26.68
|
| Rate for Payer: Cigna of CA PPO |
$25.35
|
| Rate for Payer: Cigna of CA PPO |
$13.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.48
|
| Rate for Payer: EPIC Health Plan Senior |
$7.76
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$30.78
|
| Rate for Payer: Galaxy Health WC |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$22.87
|
| Rate for Payer: Global Benefits Group Commercial |
$21.73
|
| Rate for Payer: Global Benefits Group Commercial |
$11.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: Multiplan Commercial |
$28.59
|
| Rate for Payer: Multiplan Commercial |
$27.16
|
| Rate for Payer: Multiplan Commercial |
$14.55
|
| Rate for Payer: Networks By Design Commercial |
$19.06
|
| Rate for Payer: Networks By Design Commercial |
$9.70
|
| Rate for Payer: Networks By Design Commercial |
$18.11
|
| Rate for Payer: Prime Health Services Commercial |
$30.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.40
|
| Rate for Payer: Prime Health Services Commercial |
$16.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.59
|
| Rate for Payer: United Healthcare All Other HMO |
$13.23
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare All Other HMO |
$13.93
|
| Rate for Payer: United Healthcare HMO Rider |
$6.93
|
| Rate for Payer: United Healthcare HMO Rider |
$12.94
|
| Rate for Payer: United Healthcare HMO Rider |
$13.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.35
|
|
|
POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 57250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$610.07 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Vantage Medical Group Senior |
$6,433.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,433.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,077.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,433.99
|
| 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 |
$9,993.72
|
| 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 |
$9,650.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,077.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,433.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7,077.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,551.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,433.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$673.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,007.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,621.55
|
| Rate for Payer: Multiplan WC |
$9,993.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,433.99
|
| Rate for Payer: Preferred Health Network WC |
$10,197.67
|
| Rate for Payer: Prime Health Services Medicare |
$6,820.03
|
| Rate for Payer: Prime Health Services WC |
$9,891.74
|
| Rate for Payer: Riverside University Health System MISP |
$7,077.39
|
| 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 |
$6,433.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,077.39
|
|
|
POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS 1 INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 22840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$632.67 |
| 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 |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$632.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$698.88
|
| 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
|
|
|
POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND SUBLAMINAR WIRES); 3 TO 6 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 22842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$705.03 |
| 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 |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$705.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$778.81
|
| 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
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$47,997.96
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$47,997.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,997.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31,004.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43,407.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,989.38
|
| Rate for Payer: EPIC Health Plan Senior |
$28,659.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,054.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36,475.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34,912.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26,054.17
|
| Rate for Payer: Prime Health Services Medicare |
$27,617.42
|
| 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
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$26,263.73
|
|
|
Service Code
|
MSDRG 863
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$26,263.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,263.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,965.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,752.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,196.74
|
| Rate for Payer: EPIC Health Plan Senior |
$16,131.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,664.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,530.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,650.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,664.69
|
| Rate for Payer: Prime Health Services Medicare |
$15,544.57
|
| 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
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$56,362.14
|
|
|
Service Code
|
MSDRG 857
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$56,362.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,362.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36,407.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50,971.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,221.50
|
| Rate for Payer: EPIC Health Plan Senior |
$33,481.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,437.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,612.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40,785.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30,437.27
|
| Rate for Payer: Prime Health Services Medicare |
$32,263.51
|
| 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
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$119,717.24
|
|
|
Service Code
|
MSDRG 856
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$119,717.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119,717.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$77,332.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108,268.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$105,001.86
|
| Rate for Payer: EPIC Health Plan Senior |
$70,001.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,637.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89,092.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$85,274.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$63,637.49
|
| Rate for Payer: Prime Health Services Medicare |
$67,455.74
|
| 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
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,659.74
|
|
|
Service Code
|
MSDRG 858
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$36,659.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,659.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,680.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,153.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,185.69
|
| Rate for Payer: EPIC Health Plan Senior |
$22,123.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,112.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,157.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,950.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,112.54
|
| Rate for Payer: Prime Health Services Medicare |
$21,319.29
|
| 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
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$67,783.54
|
|
|
Service Code
|
APR-DRG 7114
|
| Min. Negotiated Rate |
$42,810.66 |
| Max. Negotiated Rate |
$67,783.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$42,810.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51,016.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67,783.54
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$37,923.16
|
|
|
Service Code
|
APR-DRG 7113
|
| Min. Negotiated Rate |
$23,951.47 |
| Max. Negotiated Rate |
$37,923.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,951.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28,542.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37,923.16
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$23,876.22
|
|
|
Service Code
|
APR-DRG 7112
|
| Min. Negotiated Rate |
$15,079.72 |
| Max. Negotiated Rate |
$23,876.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,079.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,969.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,876.22
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$16,470.04
|
|
|
Service Code
|
APR-DRG 7111
|
| Min. Negotiated Rate |
$10,402.13 |
| Max. Negotiated Rate |
$16,470.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,402.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,395.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,470.04
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$20,933.48
|
|
|
Service Code
|
APR-DRG 7213
|
| Min. Negotiated Rate |
$13,221.14 |
| Max. Negotiated Rate |
$20,933.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,221.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,755.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,933.48
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$12,729.68
|
|
|
Service Code
|
APR-DRG 7212
|
| Min. Negotiated Rate |
$8,039.80 |
| Max. Negotiated Rate |
$12,729.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,039.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,580.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,729.68
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$9,172.63
|
|
|
Service Code
|
APR-DRG 7211
|
| Min. Negotiated Rate |
$5,793.24 |
| Max. Negotiated Rate |
$9,172.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,793.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,903.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,172.63
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$36,624.02
|
|
|
Service Code
|
APR-DRG 7214
|
| Min. Negotiated Rate |
$23,130.96 |
| Max. Negotiated Rate |
$36,624.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,130.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27,564.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36,624.02
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$44,473.85
|
|
|
Service Code
|
MSDRG 769
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$44,473.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,473.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28,728.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40,220.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,942.23
|
| Rate for Payer: EPIC Health Plan Senior |
$26,628.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,207.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,890.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,437.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,207.41
|
| Rate for Payer: Prime Health Services Medicare |
$25,659.85
|
| 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
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$17,231.05
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$17,231.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,231.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,130.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,583.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,386.56
|
| Rate for Payer: EPIC Health Plan Senior |
$10,924.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,931.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,903.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,307.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,931.25
|
| Rate for Payer: Prime Health Services Medicare |
$10,527.12
|
| 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
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$24,247.23
|
|
|
Service Code
|
APR-DRG 5614
|
| Min. Negotiated Rate |
$15,314.04 |
| Max. Negotiated Rate |
$24,247.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,314.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,249.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,247.23
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$12,048.49
|
|
|
Service Code
|
APR-DRG 5613
|
| Min. Negotiated Rate |
$7,609.57 |
| Max. Negotiated Rate |
$12,048.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,609.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,068.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,048.49
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$4,313.80
|
|
|
Service Code
|
APR-DRG 5611
|
| Min. Negotiated Rate |
$2,724.50 |
| Max. Negotiated Rate |
$4,313.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,724.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,246.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,313.80
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$6,717.73
|
|
|
Service Code
|
APR-DRG 5612
|
| Min. Negotiated Rate |
$4,242.78 |
| Max. Negotiated Rate |
$6,717.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,242.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,055.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,717.73
|
|
