|
Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 92018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$90.97 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,817.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$4,492.17
|
|
|
Service Code
|
APR-DRG 7731
|
| Min. Negotiated Rate |
$2,837.16 |
| Max. Negotiated Rate |
$4,492.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,837.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,380.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,492.17
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$26,293.32
|
|
|
Service Code
|
APR-DRG 7734
|
| Min. Negotiated Rate |
$16,606.31 |
| Max. Negotiated Rate |
$26,293.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,606.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,789.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,293.32
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$11,903.46
|
|
|
Service Code
|
APR-DRG 7733
|
| Min. Negotiated Rate |
$7,517.98 |
| Max. Negotiated Rate |
$11,903.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,517.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,958.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,903.46
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$6,414.61
|
|
|
Service Code
|
APR-DRG 7732
|
| Min. Negotiated Rate |
$4,051.33 |
| Max. Negotiated Rate |
$6,414.61 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,051.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,827.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,414.61
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
OP
|
$6.28
|
|
|
Service Code
|
NDC 42799-217-01
|
| Hospital Charge Code |
NDG99405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.71
|
| Rate for Payer: Blue Distinction Transplant |
$3.77
|
| Rate for Payer: Blue Shield of California Commercial |
$3.95
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.34
|
| Rate for Payer: Dignity Health Media |
$5.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.71
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
| Rate for Payer: Riverside University Health System MISP |
$2.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Vantage Medical Group Senior |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
IP
|
$6.28
|
|
|
Service Code
|
NDC 9999-9994-05
|
| Hospital Charge Code |
1715201
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Blue Shield of California Commercial |
$4.71
|
| Rate for Payer: Blue Shield of California EPN |
$3.35
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.71
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
IP
|
$6.28
|
|
|
Service Code
|
NDC 42799-217-01
|
| Hospital Charge Code |
NDG99405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Blue Shield of California Commercial |
$4.71
|
| Rate for Payer: Blue Shield of California EPN |
$3.35
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.71
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
|
OP
|
$6.28
|
|
|
Service Code
|
NDC 9999-9994-05
|
| Hospital Charge Code |
1715201
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.71
|
| Rate for Payer: Blue Distinction Transplant |
$3.77
|
| Rate for Payer: Blue Shield of California Commercial |
$3.95
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.34
|
| Rate for Payer: Dignity Health Media |
$5.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.71
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
| Rate for Payer: Riverside University Health System MISP |
$2.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Vantage Medical Group Senior |
$5.34
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$54,510.85
|
|
|
Service Code
|
APR-DRG 0734
|
| Min. Negotiated Rate |
$34,427.90 |
| Max. Negotiated Rate |
$54,510.85 |
| Rate for Payer: Adventist Health Medi-Cal |
$34,427.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41,026.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,510.85
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$28,260.09
|
|
|
Service Code
|
APR-DRG 0733
|
| Min. Negotiated Rate |
$17,848.48 |
| Max. Negotiated Rate |
$28,260.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,848.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,269.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,260.09
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$18,059.14
|
|
|
Service Code
|
APR-DRG 0732
|
| Min. Negotiated Rate |
$11,405.77 |
| Max. Negotiated Rate |
$18,059.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,405.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,591.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,059.14
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$14,226.69
|
|
|
Service Code
|
APR-DRG 0731
|
| Min. Negotiated Rate |
$8,985.28 |
| Max. Negotiated Rate |
$14,226.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,985.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,707.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,226.69
|
|
|
Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy
|
Facility
|
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 67400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$961.32 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,830.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,830.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,830.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Dignity Health Media |
$4,830.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,313.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,521.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,830.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,830.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,922.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,970.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,830.79
|
| Rate for Payer: InnovAge PACE Commercial |
$7,246.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,830.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,473.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,473.26
|
| Rate for Payer: Prime Health Services Medicare |
$5,120.64
|
| Rate for Payer: Riverside University Health System MISP |
$5,313.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4,830.79
|
|
|
Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of foreign body
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 67413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,817.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of lesion
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 67412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,008.01 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,817.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,008.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Orchiectomy, radical, for tumor; inguinal approach
|
Facility
|
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 54530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,322.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,322.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,089.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,132.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: InnovAge PACE Commercial |
$6,483.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,792.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Prime Health Services Medicare |
$4,581.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,754.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach
|
Facility
|
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 54520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,186.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,355.72
|
| Rate for Payer: InnovAge PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Riverside University Health System MISP |
$4,791.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Orchiopexy, inguinal or scrotal approach
|
Facility
|
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 54640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$848.84 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,322.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,322.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,089.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,132.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: InnovAge PACE Commercial |
$6,483.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,792.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Prime Health Services Medicare |
$4,581.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,754.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
|
IP
|
$9,523.48
|
|
|
Service Code
|
APR-DRG 7572
|
| Min. Negotiated Rate |
$6,014.83 |
| Max. Negotiated Rate |
$9,523.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,014.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,167.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,523.48
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
|
IP
|
$7,028.21
|
|
|
Service Code
|
APR-DRG 7571
|
| Min. Negotiated Rate |
$4,438.87 |
| Max. Negotiated Rate |
$7,028.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,438.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,289.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,028.21
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
|
IP
|
$14,540.60
|
|
|
Service Code
|
APR-DRG 7573
|
| Min. Negotiated Rate |
$9,183.54 |
| Max. Negotiated Rate |
$14,540.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,183.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,943.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,540.60
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
|
IP
|
$33,555.63
|
|
|
Service Code
|
APR-DRG 7574
|
| Min. Negotiated Rate |
$21,193.03 |
| Max. Negotiated Rate |
$33,555.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,193.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,255.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,555.63
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
|
OP
|
$6,036.62
|
|
|
Service Code
|
CPT J2406
|
| Hospital Charge Code |
ERX231752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$5,432.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$40.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$253.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.20
|
| Rate for Payer: Blue Distinction Transplant |
$3,621.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3,797.03
|
| Rate for Payer: Blue Shield of California EPN |
$2,951.91
|
| Rate for Payer: Caremore Medicare Advantage |
$40.92
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Central Health Plan Commercial |
$4,829.30
|
| Rate for Payer: Cigna of CA HMO |
$4,225.63
|
| Rate for Payer: Cigna of CA PPO |
$4,225.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.15
|
| Rate for Payer: Dignity Health Media |
$45.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$40.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$5,131.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3,621.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,432.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,527.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$67.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.92
|
| Rate for Payer: InnovAge PACE Commercial |
$61.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,026.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,207.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.83
|
| Rate for Payer: Multiplan Commercial |
$4,527.46
|
| Rate for Payer: Networks By Design Commercial |
$3,018.31
|
| Rate for Payer: Prime Health Services Commercial |
$5,131.13
|
| Rate for Payer: Prime Health Services Medicare |
$43.37
|
| Rate for Payer: Riverside University Health System MISP |
$45.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,621.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,621.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,018.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,018.31
|
| Rate for Payer: United Healthcare HMO Rider |
$3,018.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,018.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.01
|
| Rate for Payer: Vantage Medical Group Senior |
$45.01
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
|
IP
|
$6,036.62
|
|
|
Service Code
|
CPT J2406
|
| Hospital Charge Code |
ERX231752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,207.32 |
| Max. Negotiated Rate |
$5,432.96 |
| Rate for Payer: Blue Shield of California Commercial |
$4,527.46
|
| Rate for Payer: Blue Shield of California EPN |
$3,223.56
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Central Health Plan Commercial |
$4,829.30
|
| Rate for Payer: Cigna of CA HMO |
$4,225.63
|
| Rate for Payer: Cigna of CA PPO |
$4,225.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,414.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,414.65
|
| Rate for Payer: Galaxy Health WC |
$5,131.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3,621.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,432.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,026.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,299.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,207.32
|
| Rate for Payer: Multiplan Commercial |
$4,527.46
|
| Rate for Payer: Networks By Design Commercial |
$3,018.31
|
| Rate for Payer: Prime Health Services Commercial |
$5,131.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,279.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2,226.31
|
| Rate for Payer: United Healthcare HMO Rider |
$2,178.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,992.08
|
|
