|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
NDC 2315574703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$2.41
|
| Rate for Payer: Cigna of CA PPO |
$2.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093306156
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5.23
|
| Rate for Payer: Blue Shield of California EPN |
$3.29
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Central Health Plan Commercial |
$6.60
|
| Rate for Payer: Cigna of CA HMO |
$5.78
|
| Rate for Payer: Cigna of CA PPO |
$5.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3.30
|
| Rate for Payer: Galaxy Health WC |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
| Rate for Payer: Riverside University Health System MISP |
$3.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$4.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093306156
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California Commercial |
$6.62
|
| Rate for Payer: Blue Shield of California EPN |
$4.16
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Central Health Plan Commercial |
$6.60
|
| Rate for Payer: Cigna of CA HMO |
$5.78
|
| Rate for Payer: Cigna of CA PPO |
$5.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3.30
|
| Rate for Payer: Galaxy Health WC |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]
|
Facility
|
OP
|
$1,341.68
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.86 |
| Max. Negotiated Rate |
$2,295.73 |
| Rate for Payer: Adventist Health Commercial |
$268.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$387.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,295.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$204.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.64
|
| Rate for Payer: Blue Shield of California Commercial |
$472.79
|
| Rate for Payer: Blue Shield of California EPN |
$429.81
|
| Rate for Payer: Cash Price |
$603.76
|
| Rate for Payer: Cash Price |
$603.76
|
| Rate for Payer: Central Health Plan Commercial |
$1,073.34
|
| Rate for Payer: Cigna of CA HMO |
$939.18
|
| Rate for Payer: Cigna of CA PPO |
$939.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$426.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$426.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$939.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$639.29
|
| Rate for Payer: EPIC Health Plan Senior |
$426.19
|
| Rate for Payer: Galaxy Health WC |
$1,140.43
|
| Rate for Payer: Global Benefits Group Commercial |
$805.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,207.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$635.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$387.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$387.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$851.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$487.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$542.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$519.18
|
| Rate for Payer: Multiplan Commercial |
$1,006.26
|
| Rate for Payer: Networks By Design Commercial |
$670.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$387.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,140.43
|
| Rate for Payer: Prime Health Services Medicare |
$410.70
|
| Rate for Payer: Riverside University Health System MISP |
$426.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$805.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$805.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.53
|
| Rate for Payer: United Healthcare All Other HMO |
$490.12
|
| Rate for Payer: United Healthcare HMO Rider |
$479.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$439.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$387.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$426.19
|
| Rate for Payer: Vantage Medical Group Senior |
$426.19
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]
|
Facility
|
IP
|
$1,341.68
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$268.34 |
| Max. Negotiated Rate |
$1,207.51 |
| Rate for Payer: Adventist Health Commercial |
$268.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,076.03
|
| Rate for Payer: Blue Shield of California EPN |
$676.21
|
| Rate for Payer: Cash Price |
$603.76
|
| Rate for Payer: Central Health Plan Commercial |
$1,073.34
|
| Rate for Payer: Cigna of CA HMO |
$939.18
|
| Rate for Payer: Cigna of CA PPO |
$939.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$939.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.67
|
| Rate for Payer: EPIC Health Plan Senior |
$536.67
|
| Rate for Payer: Galaxy Health WC |
$1,140.43
|
| Rate for Payer: Global Benefits Group Commercial |
$805.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,207.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$851.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$791.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.34
|
| Rate for Payer: Multiplan Commercial |
$1,006.26
|
| Rate for Payer: Networks By Design Commercial |
$670.84
|
| Rate for Payer: Prime Health Services Commercial |
$1,140.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.53
|
| Rate for Payer: United Healthcare All Other HMO |
$490.12
|
| Rate for Payer: United Healthcare HMO Rider |
$479.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$439.40
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION [229668]
|
Facility
|
IP
|
$2,678.15
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$535.63 |
| Max. Negotiated Rate |
$2,410.34 |
| Rate for Payer: Adventist Health Commercial |
$535.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,147.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,349.79
|
| Rate for Payer: Cash Price |
$1,205.17
|
| Rate for Payer: Central Health Plan Commercial |
$2,142.52
|
| Rate for Payer: Cigna of CA HMO |
$1,874.70
|
| Rate for Payer: Cigna of CA PPO |
$1,874.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,874.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,071.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1,071.26
|
| Rate for Payer: Galaxy Health WC |
$2,276.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1,606.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,410.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,700.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,580.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.63
|
| Rate for Payer: Multiplan Commercial |
$2,008.61
|
| Rate for Payer: Networks By Design Commercial |
$1,339.08
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,005.11
|
| Rate for Payer: United Healthcare All Other HMO |
$978.33
|
| Rate for Payer: United Healthcare HMO Rider |
$957.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$877.09
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION [229668]
|
Facility
|
OP
|
$2,678.15
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$2,410.34 |
| Rate for Payer: Adventist Health Commercial |
$535.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,365.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$422.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.20
|
| Rate for Payer: Blue Shield of California Commercial |
$281.78
|
| Rate for Payer: Blue Shield of California EPN |
$256.16
|
| Rate for Payer: Cash Price |
$1,205.17
|
| Rate for Payer: Cash Price |
$1,205.17
|
| Rate for Payer: Central Health Plan Commercial |
$2,142.52
|
| Rate for Payer: Cigna of CA HMO |
$1,874.70
|
| Rate for Payer: Cigna of CA PPO |
$1,874.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,874.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.42
|
| Rate for Payer: EPIC Health Plan Senior |
$249.61
|
| Rate for Payer: Galaxy Health WC |
$2,276.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1,606.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,410.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$372.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,700.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$317.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$304.07
|
| Rate for Payer: Multiplan Commercial |
$2,008.61
|
| Rate for Payer: Networks By Design Commercial |
$1,339.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.92
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.43
|
| Rate for Payer: Prime Health Services Medicare |
$240.54
|
| Rate for Payer: Riverside University Health System MISP |
$249.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,606.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,606.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,005.11
|
| Rate for Payer: United Healthcare All Other HMO |
$978.33
|
| Rate for Payer: United Healthcare HMO Rider |
$957.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$877.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$283.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.61
|
| Rate for Payer: Vantage Medical Group Senior |
$249.61
|
|
|
REALIGNMENT OF EXTENSOR TENDON, HAND, EACH TENDON
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 26437
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.83 |
| 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 |
$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 |
$6,568.63
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$190.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.81
|
| 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
|
|
|
RECONSTRUCTION FOR STABILIZATION OF UNSTABLE DISTAL ULNA OR DISTAL RADIOULNAR JOINT, SECONDARY BY SOFT TISSUE STABILIZATION (EG, TENDON TRANSFER, TENDON GRAFT OR WEAVE, OR TENODESIS) WITH OR WITHOUT OPEN REDUCTION OF DISTAL RADIOULNAR JOINT
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 25337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$136.40 |
| 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 |
$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 |
$136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.67
|
| 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 |
$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 |
$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
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 27422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$212.59 |
| 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 |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| 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: 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 |
$212.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.84
|
| 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 |
$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 |
$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
|
|
|
RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG, FOR STENOSIS DUE TO INJURY, INFECTION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$217.72 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; SECOND STAGE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$4,723.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$492.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; TOTAL EYELID, LOWER, 1 STAGE OR FIRST STAGE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67973
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,087.97 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$4,723.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,087.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,201.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
RECONSTRUCTION OF MANDIBLE OR MAXILLA, ENDOSTEAL IMPLANT (EG, BLADE, CYLINDER); COMPLETE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 21249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,743.05 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| 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 |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,743.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,925.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$61,644.36
|
|
|
Service Code
|
MSDRG 333
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$61,644.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61,644.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39,819.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55,749.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,788.81
|
| Rate for Payer: EPIC Health Plan Senior |
$36,525.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,205.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,487.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44,495.16
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$33,205.34
|
| Rate for Payer: Prime Health Services Medicare |
$35,197.66
|
| 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
|
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$95,293.20
|
|
|
Service Code
|
MSDRG 332
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$95,293.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$95,293.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61,555.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86,179.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$83,883.48
|
| Rate for Payer: EPIC Health Plan Senior |
$55,922.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50,838.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71,173.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68,123.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$50,838.47
|
| Rate for Payer: Prime Health Services Medicare |
$53,888.78
|
| 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
|
|
|
RECTAL RESECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$43,107.89
|
|
|
Service Code
|
MSDRG 334
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$43,107.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,107.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,845.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38,985.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,761.14
|
| Rate for Payer: EPIC Health Plan Senior |
$25,840.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,491.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,888.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,478.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,491.60
|
| Rate for Payer: Prime Health Services Medicare |
$24,901.10
|
| 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
|
|
|
RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$36,959.77
|
|
|
Service Code
|
MSDRG 811
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$36,959.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,959.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,874.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,425.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,445.09
|
| Rate for Payer: EPIC Health Plan Senior |
$22,296.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,269.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,377.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,161.47
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,269.75
|
| Rate for Payer: Prime Health Services Medicare |
$21,485.94
|
| 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
|
|
|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$24,166.11
|
|
|
Service Code
|
MSDRG 812
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$24,166.11 |
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,166.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,610.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,855.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,382.99
|
| Rate for Payer: EPIC Health Plan Senior |
$14,922.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,565.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,991.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,177.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,565.45
|
| Rate for Payer: Prime Health Services Medicare |
$14,379.38
|
| 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 Select/Navigate/Core |
$6,823.00
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$130.30 |
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California EPN |
$9.00
|
| Rate for Payer: Blue Shield of California EPN |
$9.00
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Central Health Plan Commercial |
$3.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Riverside University Health System MISP |
$2.88
|
| Rate for Payer: Riverside University Health System MISP |
$1.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5.77
|
| Rate for Payer: Blue Shield of California Commercial |
$3.85
|
| Rate for Payer: Blue Shield of California EPN |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
|
|
REHABILITATION
|
Facility
|
IP
|
$24,820.86
|
|
|
Service Code
|
APR-DRG 8603
|
| Min. Negotiated Rate |
$15,676.33 |
| Max. Negotiated Rate |
$24,820.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,676.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,680.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,820.86
|
|
|
REHABILITATION
|
Facility
|
IP
|
$15,835.57
|
|
|
Service Code
|
APR-DRG 8601
|
| Min. Negotiated Rate |
$10,001.41 |
| Max. Negotiated Rate |
$15,835.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,001.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,918.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,835.57
|
|
|
REHABILITATION
|
Facility
|
IP
|
$19,036.12
|
|
|
Service Code
|
APR-DRG 8602
|
| Min. Negotiated Rate |
$12,022.81 |
| Max. Negotiated Rate |
$19,036.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,022.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,327.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,036.12
|
|
|
REHABILITATION
|
Facility
|
IP
|
$30,776.83
|
|
|
Service Code
|
APR-DRG 8604
|
| Min. Negotiated Rate |
$19,438.00 |
| Max. Negotiated Rate |
$30,776.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,438.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,163.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30,776.83
|
|
