|
ORBIT AND EYE PROCEDURES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 0732
|
| Min. Negotiated Rate |
$11,405.77 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,405.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$13,591.88
|
|
|
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 |
$3,383.18 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: AlphaCare 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: 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: IEHP medi-cal |
$7,970.80
|
| Rate for Payer: IEHP Medicare Advantage |
$4,830.79
|
| Rate for Payer: Innovage PACE Commercial |
$7,246.18
|
| 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 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 |
$2,919.67 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare 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: 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: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| 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 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 |
$2,919.67 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare 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: 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: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| 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 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 |
$4,183.44 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare 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: 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: IEHP medi-cal |
$7,132.32
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Innovage PACE Commercial |
$6,483.93
|
| 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 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 |
$3,383.18 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare 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: 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: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| 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 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 |
$4,183.44 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare 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: 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: IEHP medi-cal |
$7,132.32
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Innovage PACE Commercial |
$6,483.93
|
| 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 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 DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 884
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7571
|
| Min. Negotiated Rate |
$4,438.87 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,438.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$5,289.66
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7574
|
| Min. Negotiated Rate |
$21,193.03 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,193.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$25,255.03
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7572
|
| Min. Negotiated Rate |
$6,014.83 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,014.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$7,167.67
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 7573
|
| Min. Negotiated Rate |
$9,183.54 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,183.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$10,943.72
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$51.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.01
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$4,527.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$67.10
|
| Rate for Payer: IEHP medi-cal |
$67.51
|
| Rate for Payer: 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 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 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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: 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
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION [207378]
|
Facility
OP
|
$1,352.40
|
|
|
Service Code
|
CPT J2407
|
| Hospital Charge Code |
ERX207378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$1,217.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$27.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.39
|
| Rate for Payer: BCBS Transplant Transplant |
$811.44
|
| Rate for Payer: Blue Shield of California Commercial |
$32.86
|
| Rate for Payer: Blue Shield of California EPN |
$29.87
|
| Rate for Payer: Caremore Medicare Advantage |
$27.60
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Central Health Plan Commercial |
$1,081.92
|
| Rate for Payer: Cigna of CA HMO |
$946.68
|
| Rate for Payer: Cigna of CA PPO |
$946.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.60
|
| Rate for Payer: Galaxy Health WC |
$1,149.54
|
| Rate for Payer: Global Benefits Group Commercial |
$811.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,217.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,014.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$45.26
|
| Rate for Payer: IEHP medi-cal |
$45.53
|
| Rate for Payer: IEHP Medicare Advantage |
$27.60
|
| Rate for Payer: Innovage PACE Commercial |
$41.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.98
|
| Rate for Payer: Multiplan Commercial |
$1,014.30
|
| Rate for Payer: Networks By Design Commercial |
$676.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,149.54
|
| Rate for Payer: Prime Health Services Medicare |
$29.25
|
| Rate for Payer: Riverside University Health MISP |
$30.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.20
|
| Rate for Payer: United Healthcare All Other HMO |
$676.20
|
| Rate for Payer: United Healthcare HMO Rider |
$676.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.35
|
| Rate for Payer: Vantage Medical Group Senior |
$27.60
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION [207378]
|
Facility
IP
|
$1,352.40
|
|
|
Service Code
|
CPT J2407
|
| Hospital Charge Code |
ERX207378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$270.48 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,014.30
|
| Rate for Payer: Blue Shield of California EPN |
$722.18
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Central Health Plan Commercial |
$1,081.92
|
| Rate for Payer: Cigna of CA HMO |
$946.68
|
| Rate for Payer: Cigna of CA PPO |
$946.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$540.96
|
| Rate for Payer: Galaxy Health WC |
$1,149.54
|
| Rate for Payer: Global Benefits Group Commercial |
$811.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,217.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.48
|
| Rate for Payer: Multiplan Commercial |
$1,014.30
|
| Rate for Payer: Networks By Design Commercial |
$676.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,149.54
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]
|
Facility
IP
|
$7.20
|
|
|
Service Code
|
CPT J2360
|
| Hospital Charge Code |
NDG5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5.40
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.08
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.62
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| 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 |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$8.09
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$7.14
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$4.76
|
| Rate for Payer: Prime Health Services Commercial |
$8.09
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]
|
Facility
OP
|
$9.52
|
|
|
Service Code
|
CPT J2360
|
| Hospital Charge Code |
NDG5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$60.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.53
|
| Rate for Payer: BCBS Transplant Transplant |
$5.71
|
| Rate for Payer: BCBS Transplant Transplant |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$20.59
|
| Rate for Payer: Blue Shield of California Commercial |
$20.59
|
| Rate for Payer: Blue Shield of California EPN |
$18.72
|
| Rate for Payer: Blue Shield of California EPN |
$18.72
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.62
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$6.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$8.09
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.14
|
| Rate for Payer: IEHP medi-cal |
$9.09
|
| Rate for Payer: IEHP medi-cal |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$7.14
|
| Rate for Payer: Networks By Design Commercial |
$4.76
|
| 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 |
$8.09
|
| Rate for Payer: Riverside University Health MISP |
$2.88
|
| Rate for Payer: Riverside University Health MISP |
$3.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.09
|
| 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 |
$8.09
|
|
|
O.R. PROCEDURES FOR OBESITY WITH CC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 620
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
O.R. PROCEDURES FOR OBESITY WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 619
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 621
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 940
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 939
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 941
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 876
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
