|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2223
|
| Min. Negotiated Rate |
$18,877.82 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,877.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$22,496.07
|
|
|
OTHER VASCULAR PROCEDURES WITH CC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 253
|
| 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
|
|
|
OTHER VASCULAR PROCEDURES WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 252
|
| 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
|
|
|
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 254
|
| 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
|
|
|
OTITIS MEDIA AND URI AGE 0-17
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 112
|
| 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
|
|
|
OTITIS MEDIA AND URI AGE >17 WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 152
|
| 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
|
|
|
OTITIS MEDIA AND URI AGE >17 WITHOUT MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 153
|
| 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
|
|
|
Otolaryngologic examination under general anesthesia
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 92502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.12 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$687.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$564.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: IEHP medi-cal |
$1,134.28
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Innovage PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Riverside University Health MISP |
$756.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
Otoplasty, protruding ear, with or without size reduction
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 69300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| 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 |
$4,022.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: IEHP medi-cal |
$6,637.44
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Innovage PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health MISP |
$4,424.96
|
| 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 |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
Outdated MS-DRG 222
|
Facility
IP
|
$164,601.68
|
|
|
Service Code
|
MS-DRG 222
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$164,601.68 |
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$161,309.65
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,764.00
|
| Rate for Payer: Multiplan WC |
$161,309.65
|
| Rate for Payer: Preferred Health Network WC |
$164,601.68
|
| Rate for Payer: Prime Health Services WC |
$159,663.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$127,379.00
|
| Rate for Payer: United Healthcare All Other HMO |
$127,379.00
|
| Rate for Payer: United Healthcare HMO Rider |
$127,379.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127,379.00
|
|
|
Outdated MS-DRG 223
|
Facility
IP
|
$112,191.68
|
|
|
Service Code
|
MS-DRG 223
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$112,191.68 |
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$109,947.85
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,764.00
|
| Rate for Payer: Multiplan WC |
$109,947.85
|
| Rate for Payer: Preferred Health Network WC |
$112,191.68
|
| Rate for Payer: Prime Health Services WC |
$108,825.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$109,242.00
|
| Rate for Payer: United Healthcare All Other HMO |
$109,242.00
|
| Rate for Payer: United Healthcare HMO Rider |
$109,242.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109,242.00
|
|
|
Outdated MS-DRG 224
|
Facility
IP
|
$152,403.71
|
|
|
Service Code
|
MS-DRG 224
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$152,403.71 |
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$149,355.64
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,764.00
|
| Rate for Payer: Multiplan WC |
$149,355.64
|
| Rate for Payer: Preferred Health Network WC |
$152,403.71
|
| Rate for Payer: Prime Health Services WC |
$147,831.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114,283.00
|
| Rate for Payer: United Healthcare All Other HMO |
$114,283.00
|
| Rate for Payer: United Healthcare HMO Rider |
$114,283.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114,283.00
|
|
|
Outdated MS-DRG 225
|
Facility
IP
|
$108,730.50
|
|
|
Service Code
|
MS-DRG 225
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$108,730.50 |
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$106,555.89
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,764.00
|
| Rate for Payer: Multiplan WC |
$106,555.89
|
| Rate for Payer: Preferred Health Network WC |
$108,730.50
|
| Rate for Payer: Prime Health Services WC |
$105,468.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$99,952.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99,952.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99,952.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99,952.00
|
|
|
Outdated MS-DRG 226
|
Facility
IP
|
$137,606.63
|
|
|
Service Code
|
MS-DRG 226
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$137,606.63 |
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$134,854.50
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,764.00
|
| Rate for Payer: Multiplan WC |
$134,854.50
|
| Rate for Payer: Preferred Health Network WC |
$137,606.63
|
| Rate for Payer: Prime Health Services WC |
$133,478.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$94,610.00
|
| Rate for Payer: United Healthcare All Other HMO |
$94,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$94,610.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94,610.00
|
|
|
Outdated MS-DRG 227
|
Facility
IP
|
$107,935.07
|
|
|
Service Code
|
MS-DRG 227
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$107,935.07 |
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$105,776.37
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,764.00
|
| Rate for Payer: Multiplan WC |
$105,776.37
|
| Rate for Payer: Preferred Health Network WC |
$107,935.07
|
| Rate for Payer: Prime Health Services WC |
$104,697.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$107,228.00
|
| Rate for Payer: United Healthcare All Other HMO |
$107,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$107,228.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107,228.00
|
|
|
Outdated MS-DRG 230
|
Facility
IP
|
$148,568.00
|
|
|
Service Code
|
MS-DRG 230
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$148,568.00 |
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25,651.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$148,568.00
|
| Rate for Payer: United Healthcare All Other HMO |
$148,568.00
|
| Rate for Payer: United Healthcare HMO Rider |
$148,568.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148,568.00
|
|
|
Outdated MS-DRG 237
|
Facility
IP
|
$86,600.00
|
|
|
Service Code
|
MS-DRG 237
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$86,600.00 |
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$86,600.00
|
| Rate for Payer: United Healthcare All Other HMO |
$86,600.00
|
| Rate for Payer: United Healthcare HMO Rider |
$86,600.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86,600.00
|
|
|
Outdated MS-DRG 238
|
Facility
IP
|
$73,293.00
|
|
|
Service Code
|
MS-DRG 238
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$73,293.00 |
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$73,293.00
|
| Rate for Payer: United Healthcare All Other HMO |
$73,293.00
|
| Rate for Payer: United Healthcare HMO Rider |
$73,293.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,293.00
|
|
|
Outdated MS-DRG 246
|
Facility
IP
|
$64,395.15
|
|
|
Service Code
|
MS-DRG 246
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$64,395.15 |
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$63,107.25
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,978.00
|
| Rate for Payer: Multiplan WC |
$63,107.25
|
| Rate for Payer: Preferred Health Network WC |
$64,395.15
|
| Rate for Payer: Prime Health Services WC |
$62,463.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$48,629.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,629.00
|
| Rate for Payer: United Healthcare HMO Rider |
$48,629.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48,629.00
|
|
|
Outdated MS-DRG 247
|
Facility
IP
|
$49,935.00
|
|
|
Service Code
|
MS-DRG 247
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$49,935.00 |
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$40,229.44
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,978.00
|
| Rate for Payer: Multiplan WC |
$40,229.44
|
| Rate for Payer: Preferred Health Network WC |
$41,050.45
|
| Rate for Payer: Prime Health Services WC |
$39,818.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$49,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$49,935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$49,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,935.00
|
|
|
Outdated MS-DRG 248
|
Facility
IP
|
$64,704.72
|
|
|
Service Code
|
MS-DRG 248
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$64,704.72 |
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$63,410.63
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,978.00
|
| Rate for Payer: Multiplan WC |
$63,410.63
|
| Rate for Payer: Preferred Health Network WC |
$64,704.72
|
| Rate for Payer: Prime Health Services WC |
$62,763.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$27,797.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,797.00
|
| Rate for Payer: United Healthcare HMO Rider |
$27,797.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27,797.00
|
|
|
Outdated MS-DRG 249
|
Facility
IP
|
$40,735.00
|
|
|
Service Code
|
MS-DRG 249
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$40,735.00 |
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$38,274.33
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,978.00
|
| Rate for Payer: Multiplan WC |
$38,274.33
|
| Rate for Payer: Preferred Health Network WC |
$39,055.44
|
| Rate for Payer: Prime Health Services WC |
$37,883.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$40,735.00
|
| Rate for Payer: United Healthcare All Other HMO |
$40,735.00
|
| Rate for Payer: United Healthcare HMO Rider |
$40,735.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40,735.00
|
|
|
Outdated MS-DRG 338
|
Facility
IP
|
$57,109.47
|
|
|
Service Code
|
MS-DRG 338
|
| Min. Negotiated Rate |
$45,163.16 |
| Max. Negotiated Rate |
$57,109.47 |
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45,163.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55,475.69
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$55,967.28
|
| Rate for Payer: Multiplan WC |
$55,967.28
|
| Rate for Payer: Preferred Health Network WC |
$57,109.47
|
| Rate for Payer: Prime Health Services WC |
$55,396.19
|
|
|
Outdated MS-DRG 339
|
Facility
IP
|
$55,475.69
|
|
|
Service Code
|
MS-DRG 339
|
| Min. Negotiated Rate |
$27,684.43 |
| Max. Negotiated Rate |
$55,475.69 |
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,684.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55,475.69
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$34,307.21
|
| Rate for Payer: Multiplan WC |
$34,307.21
|
| Rate for Payer: Preferred Health Network WC |
$35,007.36
|
| Rate for Payer: Prime Health Services WC |
$33,957.14
|
|
|
Outdated MS-DRG 340
|
Facility
IP
|
$25,795.46
|
|
|
Service Code
|
MS-DRG 340
|
| Min. Negotiated Rate |
$20,399.50 |
| Max. Negotiated Rate |
$25,795.46 |
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,399.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,057.51
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$25,279.55
|
| Rate for Payer: Multiplan WC |
$25,279.55
|
| Rate for Payer: Preferred Health Network WC |
$25,795.46
|
| Rate for Payer: Prime Health Services WC |
$25,021.60
|
|
