|
RESPIRATORY NEOPLASMS WITH CC
|
Facility
|
IP
|
$28,187.65
|
|
|
Service Code
|
MSDRG 181
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$28,187.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,187.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18,208.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,491.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,860.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17,240.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,672.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,942.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,001.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15,672.88
|
| Rate for Payer: Prime Health Services Medicare |
$16,613.25
|
| 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
|
|
|
RESPIRATORY NEOPLASMS WITH MCC
|
Facility
|
IP
|
$46,479.35
|
|
|
Service Code
|
MSDRG 180
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$46,479.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,479.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30,023.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42,034.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,676.26
|
| Rate for Payer: EPIC Health Plan Senior |
$27,784.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,258.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,361.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,846.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,258.34
|
| Rate for Payer: Prime Health Services Medicare |
$26,773.84
|
| 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
|
|
|
RESPIRATORY NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,581.34
|
|
|
Service Code
|
MSDRG 182
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$19,581.34 |
| Rate for Payer: EPIC Health Plan Senior |
$12,427.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19,581.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,648.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,708.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,641.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,298.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,817.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,139.37
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,298.04
|
| Rate for Payer: Prime Health Services Medicare |
$11,975.92
|
| 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
|
|
|
RESPIRATORY SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$21,249.96
|
|
|
Service Code
|
MSDRG 204
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$21,249.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,249.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,726.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,861.53
|
| Rate for Payer: EPIC Health Plan Senior |
$13,241.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,037.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,852.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,129.97
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,037.29
|
| Rate for Payer: Prime Health Services Medicare |
$12,759.53
|
| 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
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
|
IP
|
$25,364.70
|
|
|
Service Code
|
APR-DRG 1444
|
| Min. Negotiated Rate |
$16,019.81 |
| Max. Negotiated Rate |
$25,364.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,019.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,090.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,364.70
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
|
IP
|
$11,295.58
|
|
|
Service Code
|
APR-DRG 1442
|
| Min. Negotiated Rate |
$7,134.05 |
| Max. Negotiated Rate |
$11,295.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,134.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,501.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,295.58
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
|
IP
|
$7,945.97
|
|
|
Service Code
|
APR-DRG 1441
|
| Min. Negotiated Rate |
$5,018.51 |
| Max. Negotiated Rate |
$7,945.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,018.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,980.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,945.97
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
|
IP
|
$15,940.30
|
|
|
Service Code
|
APR-DRG 1443
|
| Min. Negotiated Rate |
$10,067.56 |
| Max. Negotiated Rate |
$15,940.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,067.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,997.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,940.30
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS
|
Facility
|
IP
|
$72,343.04
|
|
|
Service Code
|
MSDRG 208
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$72,343.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$72,343.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46,730.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65,424.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$64,039.49
|
| Rate for Payer: EPIC Health Plan Senior |
$42,692.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,811.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54,336.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52,007.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38,811.81
|
| Rate for Payer: Prime Health Services Medicare |
$41,140.52
|
| 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
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$44,529.71
|
|
|
Service Code
|
APR-DRG 1301
|
| Min. Negotiated Rate |
$28,124.03 |
| Max. Negotiated Rate |
$44,529.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$28,124.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33,514.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44,529.71
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$91,083.68
|
|
|
Service Code
|
APR-DRG 1304
|
| Min. Negotiated Rate |
$57,526.54 |
| Max. Negotiated Rate |
$91,083.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$57,526.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68,552.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91,083.68
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$55,579.56
|
|
|
Service Code
|
APR-DRG 1302
|
| Min. Negotiated Rate |
$35,102.88 |
| Max. Negotiated Rate |
$55,579.56 |
| Rate for Payer: Adventist Health Medi-Cal |
$35,102.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41,830.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55,579.56
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$68,113.86
|
|
|
Service Code
|
APR-DRG 1303
|
| Min. Negotiated Rate |
$43,019.28 |
| Max. Negotiated Rate |
$68,113.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$43,019.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51,264.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68,113.86
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$169,354.87
|
|
|
Service Code
|
MSDRG 207
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$169,354.87 |
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169,354.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109,396.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153,158.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$147,921.35
|
| Rate for Payer: EPIC Health Plan Senior |
$98,614.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$89,649.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125,509.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$120,130.06
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$89,649.30
|
| Rate for Payer: Prime Health Services Medicare |
$95,028.26
|
| 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
|
|
|
RESP ONLY: HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION 30 ML [40810176]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$8.82 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.76
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
RESP ONLY: HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION 30 ML [40810176]
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC
|
Facility
|
IP
|
$26,687.47
|
|
|
Service Code
|
MSDRG 815
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$26,687.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,687.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,239.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,135.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,563.09
|
| Rate for Payer: EPIC Health Plan Senior |
$16,375.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,886.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,841.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,948.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,886.72
|
| Rate for Payer: Prime Health Services Medicare |
$15,779.92
|
| 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
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC
|
Facility
|
IP
|
$55,972.62
|
|
|
Service Code
|
MSDRG 814
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$55,972.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,972.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36,156.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50,619.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,884.73
|
| Rate for Payer: EPIC Health Plan Senior |
$33,256.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,233.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,326.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40,512.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30,233.17
|
| Rate for Payer: Prime Health Services Medicare |
$32,047.16
|
| 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
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$16,633.61
|
|
|
Service Code
|
MSDRG 816
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$16,633.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,633.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,744.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,042.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,869.98
|
| Rate for Payer: EPIC Health Plan Senior |
$10,579.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,618.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,465.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,888.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,618.17
|
| Rate for Payer: Prime Health Services Medicare |
$10,195.26
|
| 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
|
|
|
RETIFANLIMAB-DLWR 500 MG/20 ML INTRAVENOUS SOLUTION [237494]
|
Facility
|
OP
|
$902.28
|
|
|
Service Code
|
HCPCS J9345
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$812.05 |
| Rate for Payer: Adventist Health Commercial |
$180.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$30.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.27
|
| Rate for Payer: Blue Shield of California Commercial |
$38.16
|
| Rate for Payer: Blue Shield of California EPN |
$34.69
|
| Rate for Payer: Cash Price |
$406.03
|
| Rate for Payer: Cash Price |
$406.03
|
| Rate for Payer: Central Health Plan Commercial |
$721.82
|
| Rate for Payer: Cigna of CA HMO |
$631.60
|
| Rate for Payer: Cigna of CA PPO |
$631.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$631.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.12
|
| Rate for Payer: EPIC Health Plan Senior |
$34.08
|
| Rate for Payer: Galaxy Health WC |
$766.94
|
| Rate for Payer: Global Benefits Group Commercial |
$541.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$812.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$676.71
|
| Rate for Payer: Networks By Design Commercial |
$451.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30.98
|
| Rate for Payer: Prime Health Services Commercial |
$766.94
|
| Rate for Payer: Prime Health Services Medicare |
$32.84
|
| Rate for Payer: Riverside University Health System MISP |
$34.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$541.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$541.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$338.63
|
| Rate for Payer: United Healthcare All Other HMO |
$329.60
|
| Rate for Payer: United Healthcare HMO Rider |
$322.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$295.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$34.08
|
|
|
RETIFANLIMAB-DLWR 500 MG/20 ML INTRAVENOUS SOLUTION [237494]
|
Facility
|
IP
|
$902.28
|
|
|
Service Code
|
HCPCS J9345
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.46 |
| Max. Negotiated Rate |
$812.05 |
| Rate for Payer: Adventist Health Commercial |
$180.46
|
| Rate for Payer: Blue Shield of California Commercial |
$723.63
|
| Rate for Payer: Blue Shield of California EPN |
$454.75
|
| Rate for Payer: Cash Price |
$406.03
|
| Rate for Payer: Central Health Plan Commercial |
$721.82
|
| Rate for Payer: Cigna of CA HMO |
$631.60
|
| Rate for Payer: Cigna of CA PPO |
$631.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$631.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.91
|
| Rate for Payer: EPIC Health Plan Senior |
$360.91
|
| Rate for Payer: Galaxy Health WC |
$766.94
|
| Rate for Payer: Global Benefits Group Commercial |
$541.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$812.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$532.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.46
|
| Rate for Payer: Multiplan Commercial |
$676.71
|
| Rate for Payer: Networks By Design Commercial |
$451.14
|
| Rate for Payer: Prime Health Services Commercial |
$766.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$338.63
|
| Rate for Payer: United Healthcare All Other HMO |
$329.60
|
| Rate for Payer: United Healthcare HMO Rider |
$322.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$295.50
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL AND POPLITEAL VASCULAR TERRITORY, WITH TRANSLUMINAL ANGIOPLASTY, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME ARTERY, UNILATERAL; STRAIGHTFORWARD LESION, INITIAL VESSEL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 37263
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,320.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| 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: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,078.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8,052.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,005.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,248.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Prime Health Services Medicare |
$7,759.52
|
| Rate for Payer: Riverside University Health System MISP |
$8,052.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,320.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL AND POPLITEAL VASCULAR TERRITORY, WITH TRANSLUMINAL ATHERECTOMY, INCLUDING TRANSLUMINAL ANGIOPLASTY WHEN PERFORMED, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ATHERECTOMY AND ANGIOPLASTY WHEN PERFORMED, WITHIN THE SAME ARTERY, UNILATERAL; COMPLEX LESION, INITIAL VESSEL
|
Facility
|
OP
|
$38,902.96
|
|
|
Service Code
|
CPT 37273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$38,902.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED
|
Facility
|
OP
|
$50,447.00
|
|
|
Service Code
|
CPT 37225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$50,447.00 |
| 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: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL ANGIOPLASTY
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 37224
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
|
