|
SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$46,288.10
|
|
|
Service Code
|
APR-DRG 3123
|
| Min. Negotiated Rate |
$29,234.59 |
| Max. Negotiated Rate |
$46,288.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$29,234.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34,837.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46,288.10
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
|
IP
|
$40,823.61
|
|
|
Service Code
|
APR-DRG 3613
|
| Min. Negotiated Rate |
$25,783.33 |
| Max. Negotiated Rate |
$40,823.61 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,783.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30,725.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,823.61
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
|
IP
|
$22,226.58
|
|
|
Service Code
|
APR-DRG 3611
|
| Min. Negotiated Rate |
$14,037.84 |
| Max. Negotiated Rate |
$22,226.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,037.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,728.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,226.58
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
|
IP
|
$29,528.03
|
|
|
Service Code
|
APR-DRG 3612
|
| Min. Negotiated Rate |
$18,649.28 |
| Max. Negotiated Rate |
$29,528.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,649.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,223.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,528.03
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
|
IP
|
$77,779.96
|
|
|
Service Code
|
APR-DRG 3614
|
| Min. Negotiated Rate |
$49,124.18 |
| Max. Negotiated Rate |
$77,779.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$49,124.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58,539.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77,779.96
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
|
IP
|
$91,363.78
|
|
|
Service Code
|
MSDRG 574
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$91,363.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$91,363.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59,017.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82,626.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$80,485.85
|
| Rate for Payer: EPIC Health Plan Senior |
$53,657.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48,779.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68,291.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65,364.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48,779.30
|
| Rate for Payer: Prime Health Services Medicare |
$51,706.06
|
| 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
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
|
IP
|
$172,426.30
|
|
|
Service Code
|
MSDRG 573
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$172,426.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$172,426.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111,380.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155,936.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$150,577.05
|
| Rate for Payer: EPIC Health Plan Senior |
$100,384.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$91,258.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127,762.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$122,286.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$91,258.82
|
| Rate for Payer: Prime Health Services Medicare |
$96,734.35
|
| 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
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$42,994.72
|
|
|
Service Code
|
MSDRG 575
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$42,994.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,994.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,772.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38,882.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,381.75
|
| Rate for Payer: EPIC Health Plan Senior |
$28,254.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,685.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,960.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34,419.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,685.91
|
| Rate for Payer: Prime Health Services Medicare |
$27,227.06
|
| 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
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$47,213.65
|
|
|
Service Code
|
MSDRG 623
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$47,213.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,213.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30,498.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42,698.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,311.21
|
| Rate for Payer: EPIC Health Plan Senior |
$28,207.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,643.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,900.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34,361.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,643.16
|
| Rate for Payer: Prime Health Services Medicare |
$27,181.75
|
| 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
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$93,674.58
|
|
|
Service Code
|
MSDRG 622
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$93,674.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$93,674.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60,509.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84,716.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$82,483.93
|
| Rate for Payer: EPIC Health Plan Senior |
$54,989.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49,990.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69,986.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$66,986.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49,990.26
|
| Rate for Payer: Prime Health Services Medicare |
$52,989.68
|
| 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
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$32,948.76
|
|
|
Service Code
|
MSDRG 624
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$32,948.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,948.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21,283.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,797.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,976.99
|
| Rate for Payer: EPIC Health Plan Senior |
$19,984.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,167.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25,435.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24,344.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18,167.87
|
| Rate for Payer: Prime Health Services Medicare |
$19,257.94
|
| 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
|
|
|
SKIN GRAFTS FOR INJURIES WITH CC/MCC
|
Facility
|
IP
|
$96,672.32
|
|
|
Service Code
|
MSDRG 904
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$96,672.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$96,672.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62,446.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87,427.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$85,075.93
|
| Rate for Payer: EPIC Health Plan Senior |
$56,717.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51,561.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72,185.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$69,091.97
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51,561.17
|
| Rate for Payer: Prime Health Services Medicare |
$54,654.84
|
| 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
|
|
|
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,683.54
|
|
|
Service Code
|
MSDRG 905
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$37,683.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,683.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,342.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,079.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,245.19
|
| Rate for Payer: EPIC Health Plan Senior |
$23,496.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,360.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,905.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,623.36
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,360.72
|
| Rate for Payer: Prime Health Services Medicare |
$22,642.36
|
| 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
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$16,173.94
|
|
|
Service Code
|
APR-DRG 3803
|
| Min. Negotiated Rate |
$10,215.12 |
| Max. Negotiated Rate |
$16,173.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,215.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,173.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,173.94
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$8,562.33
|
|
|
Service Code
|
APR-DRG 3801
|
| Min. Negotiated Rate |
$5,407.79 |
| Max. Negotiated Rate |
$8,562.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,407.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,444.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,562.33
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$26,800.81
|
|
|
Service Code
|
APR-DRG 3804
|
| Min. Negotiated Rate |
$16,926.83 |
| Max. Negotiated Rate |
$26,800.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,926.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,171.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,800.81
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$11,067.98
|
|
|
Service Code
|
APR-DRG 3802
|
| Min. Negotiated Rate |
$6,990.30 |
| Max. Negotiated Rate |
$11,067.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,990.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,330.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,067.98
|
|
|
SKIN ULCERS WITH CC
|
Facility
|
IP
|
$31,222.23
|
|
|
Service Code
|
MSDRG 593
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$31,222.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,222.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,168.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,236.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,484.12
|
| Rate for Payer: EPIC Health Plan Senior |
$18,989.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,263.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,168.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,132.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,263.10
|
| Rate for Payer: Prime Health Services Medicare |
$18,298.89
|
| 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
|
|
|
SKIN ULCERS WITH MCC
|
Facility
|
IP
|
$50,935.16
|
|
|
Service Code
|
MSDRG 592
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$50,935.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50,935.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32,902.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,064.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,529.01
|
| Rate for Payer: EPIC Health Plan Senior |
$30,352.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,593.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,630.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36,975.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27,593.34
|
| Rate for Payer: Prime Health Services Medicare |
$29,248.94
|
| 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
|
|
|
SKIN ULCERS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,813.31
|
|
|
Service Code
|
MSDRG 594
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$22,813.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,813.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,736.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,631.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,213.27
|
| Rate for Payer: EPIC Health Plan Senior |
$14,142.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,856.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,999.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,227.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,856.53
|
| Rate for Payer: Prime Health Services Medicare |
$13,627.92
|
| 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
|
|
|
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 57288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,333.43 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,433.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,077.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,433.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$9,993.72
|
| 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 |
$9,650.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,077.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,433.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7,077.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,551.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,333.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,433.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,472.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,007.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,621.55
|
| Rate for Payer: Multiplan WC |
$9,993.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,433.99
|
| Rate for Payer: Preferred Health Network WC |
$10,197.67
|
| Rate for Payer: Prime Health Services Medicare |
$6,820.03
|
| Rate for Payer: Prime Health Services WC |
$9,891.74
|
| Rate for Payer: Riverside University Health System MISP |
$7,077.39
|
| 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 |
$6,433.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,650.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,077.39
|
| Rate for Payer: Vantage Medical Group Senior |
$6,433.99
|
|
|
SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 54001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,688.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| 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 |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 44365
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$446.98 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| 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 |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
SNIP INCISION OF LACRIMAL PUNCTUM
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 68440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$204.92 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$408.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$571.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$408.24
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Medicare |
$432.73
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$449.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [7301]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
|
