|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$13,142.58
|
|
|
Service Code
|
APR-DRG 0572
|
| Min. Negotiated Rate |
$8,300.58 |
| Max. Negotiated Rate |
$13,142.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,300.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,891.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,142.58
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$8,453.56
|
|
|
Service Code
|
APR-DRG 0571
|
| Min. Negotiated Rate |
$5,339.09 |
| Max. Negotiated Rate |
$8,453.56 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,339.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,362.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,453.56
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$18,629.23
|
|
|
Service Code
|
APR-DRG 0573
|
| Min. Negotiated Rate |
$11,765.83 |
| Max. Negotiated Rate |
$18,629.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,765.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,020.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,629.23
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$31,604.66
|
|
|
Service Code
|
APR-DRG 0574
|
| Min. Negotiated Rate |
$19,960.84 |
| Max. Negotiated Rate |
$31,604.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,960.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,786.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,604.66
|
|
|
CONCUSSION WITH CC
|
Facility
|
IP
|
$28,914.05
|
|
|
Service Code
|
MSDRG 089
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$28,914.05 |
| Rate for Payer: EPIC Health Plan Senior |
$17,658.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28,914.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18,677.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,148.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,488.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,053.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,474.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,511.76
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,053.55
|
| Rate for Payer: Prime Health Services Medicare |
$17,016.76
|
| 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
|
|
|
CONCUSSION WITH MCC
|
Facility
|
IP
|
$35,578.02
|
|
|
Service Code
|
MSDRG 088
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$35,578.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,578.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,981.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32,175.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,250.39
|
| Rate for Payer: EPIC Health Plan Senior |
$21,500.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,545.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,363.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,191.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19,545.69
|
| Rate for Payer: Prime Health Services Medicare |
$20,718.43
|
| 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
|
|
|
CONCUSSION WITHOUT CC/MCC
|
Facility
|
IP
|
$21,665.80
|
|
|
Service Code
|
MSDRG 090
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$21,665.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,665.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,995.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,593.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$13,480.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,255.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,157.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,421.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,255.21
|
| Rate for Payer: Prime Health Services Medicare |
$12,990.52
|
| 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
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 57520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$557.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,163.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| 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 |
$6,436.87
|
| 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 |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$557.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$615.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| 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 |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET [9973]
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
NDC 0046110081
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.07
|
| Rate for Payer: Blue Shield of California Commercial |
$5.53
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Central Health Plan Commercial |
$6.98
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
| Rate for Payer: Riverside University Health System MISP |
$3.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.41
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET [9973]
|
Facility
|
IP
|
$8.72
|
|
|
Service Code
|
NDC 0046110081
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.99
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Central Health Plan Commercial |
$6.98
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [9977]
|
Facility
|
IP
|
$18.93
|
|
|
Service Code
|
NDC 0046087221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$17.04 |
| Rate for Payer: Adventist Health Commercial |
$3.79
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.54
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Central Health Plan Commercial |
$15.14
|
| Rate for Payer: Cigna of CA HMO |
$13.25
|
| Rate for Payer: Cigna of CA PPO |
$13.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.57
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$16.09
|
| Rate for Payer: Global Benefits Group Commercial |
$11.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
| Rate for Payer: Networks By Design Commercial |
$12.30
|
| Rate for Payer: Prime Health Services Commercial |
$16.09
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [9977]
|
Facility
|
OP
|
$18.93
|
|
|
Service Code
|
NDC 0046087221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$17.04 |
| Rate for Payer: Adventist Health Commercial |
$3.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.01
|
| Rate for Payer: Blue Shield of California Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California EPN |
$7.55
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Central Health Plan Commercial |
$15.14
|
| Rate for Payer: Cigna of CA HMO |
$13.25
|
| Rate for Payer: Cigna of CA PPO |
$13.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.57
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$16.09
|
| Rate for Payer: Global Benefits Group Commercial |
$11.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
| Rate for Payer: Networks By Design Commercial |
$12.30
|
| Rate for Payer: Prime Health Services Commercial |
$16.09
|
| Rate for Payer: Riverside University Health System MISP |
$7.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9.46
|
| Rate for Payer: United Healthcare HMO Rider |
$9.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.09
|
| Rate for Payer: Vantage Medical Group Senior |
$16.09
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET [9974]
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
NDC 0046110281
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.07
|
| Rate for Payer: Blue Shield of California Commercial |
$5.53
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Central Health Plan Commercial |
$6.98
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
| Rate for Payer: Riverside University Health System MISP |
$3.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.41
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET [9974]
|
Facility
|
IP
|
$8.72
|
|
|
Service Code
|
NDC 0046110281
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.99
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Central Health Plan Commercial |
$6.98
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]
|
Facility
|
IP
|
$464.47
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.89 |
| Max. Negotiated Rate |
$418.02 |
| Rate for Payer: Adventist Health Commercial |
$92.89
|
| Rate for Payer: Blue Shield of California Commercial |
$372.50
|
| Rate for Payer: Blue Shield of California EPN |
$234.09
|
| Rate for Payer: Cash Price |
$209.01
|
| Rate for Payer: Central Health Plan Commercial |
$371.58
|
| Rate for Payer: Cigna of CA HMO |
$325.13
|
| Rate for Payer: Cigna of CA PPO |
$325.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$325.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.79
|
| Rate for Payer: EPIC Health Plan Senior |
$185.79
|
| Rate for Payer: Galaxy Health WC |
$394.80
|
| Rate for Payer: Global Benefits Group Commercial |
$278.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$418.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$294.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$274.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.89
|
| Rate for Payer: Multiplan Commercial |
$348.35
|
| Rate for Payer: Networks By Design Commercial |
$232.24
|
| Rate for Payer: Prime Health Services Commercial |
$394.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.32
|
| Rate for Payer: United Healthcare All Other HMO |
$169.67
|
| Rate for Payer: United Healthcare HMO Rider |
$166.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.11
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]
|
Facility
|
OP
|
$464.47
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.89 |
| Max. Negotiated Rate |
$2,372.80 |
| Rate for Payer: Adventist Health Commercial |
$92.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$401.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,372.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$501.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$441.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$441.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.10
|
| Rate for Payer: Blue Shield of California Commercial |
$485.83
|
| Rate for Payer: Blue Shield of California EPN |
$441.66
|
| Rate for Payer: Cash Price |
$209.01
|
| Rate for Payer: Cash Price |
$209.01
|
| Rate for Payer: Central Health Plan Commercial |
$371.58
|
| Rate for Payer: Cigna of CA HMO |
$325.13
|
| Rate for Payer: Cigna of CA PPO |
$325.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$501.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$441.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$441.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$325.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.48
|
| Rate for Payer: EPIC Health Plan Senior |
$441.65
|
| Rate for Payer: Galaxy Health WC |
$394.80
|
| Rate for Payer: Global Benefits Group Commercial |
$278.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$418.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$658.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$401.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$401.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$294.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$752.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$538.01
|
| Rate for Payer: Multiplan Commercial |
$348.35
|
| Rate for Payer: Networks By Design Commercial |
$232.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$401.50
|
| Rate for Payer: Prime Health Services Commercial |
$394.80
|
| Rate for Payer: Prime Health Services Medicare |
$425.59
|
| Rate for Payer: Riverside University Health System MISP |
$441.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$278.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.32
|
| Rate for Payer: United Healthcare All Other HMO |
$169.67
|
| Rate for Payer: United Healthcare HMO Rider |
$166.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$401.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$501.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$441.65
|
| Rate for Payer: Vantage Medical Group Senior |
$441.65
|
|
|
CONJUNCTIVOPLASTY; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 68320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$768.43 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$4,723.01
|
| 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: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$768.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$10,526.15
|
|
|
Service Code
|
APR-DRG 3461
|
| Min. Negotiated Rate |
$6,648.10 |
| Max. Negotiated Rate |
$10,526.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,648.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,922.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,526.15
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$21,721.03
|
|
|
Service Code
|
APR-DRG 3463
|
| Min. Negotiated Rate |
$13,718.54 |
| Max. Negotiated Rate |
$21,721.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,718.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,347.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,721.03
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$41,607.13
|
|
|
Service Code
|
APR-DRG 3464
|
| Min. Negotiated Rate |
$26,278.19 |
| Max. Negotiated Rate |
$41,607.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,278.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31,314.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41,607.13
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$14,467.93
|
|
|
Service Code
|
APR-DRG 3462
|
| Min. Negotiated Rate |
$9,137.64 |
| Max. Negotiated Rate |
$14,467.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,137.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,889.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,467.93
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$30,356.33
|
|
|
Service Code
|
MSDRG 546
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$30,356.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,356.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,608.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,453.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,735.43
|
| Rate for Payer: EPIC Health Plan Senior |
$18,490.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,809.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,533.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,524.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,809.35
|
| Rate for Payer: Prime Health Services Medicare |
$17,817.91
|
| 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
|
|
|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$65,315.86
|
|
|
Service Code
|
MSDRG 545
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$65,315.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65,315.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42,191.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59,069.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,963.39
|
| Rate for Payer: EPIC Health Plan Senior |
$38,642.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35,129.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49,181.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47,073.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35,129.33
|
| Rate for Payer: Prime Health Services Medicare |
$37,237.09
|
| 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
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,007.95
|
|
|
Service Code
|
MSDRG 547
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$22,007.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,007.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,216.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,903.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,516.96
|
| Rate for Payer: EPIC Health Plan Senior |
$13,677.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,434.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,408.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,662.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,434.52
|
| Rate for Payer: Prime Health Services Medicare |
$13,180.59
|
| 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
|
|
|
CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY;
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$153.05 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$153.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
