|
CONSTRUCTION OF TRACHEOESOPHAGEAL FISTULA AND SUBSEQUENT INSERTION OF AN ALARYNGEAL SPEECH PROSTHESIS (EG, VOICE BUTTON, BLOM-SINGER PROSTHESIS)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31611
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,152.64 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,264.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| 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 |
$6,565.51
|
| 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 |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,152.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,273.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,969.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| 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: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$16,965.52
|
|
|
Service Code
|
APR-DRG 3843
|
| Min. Negotiated Rate |
$10,715.06 |
| Max. Negotiated Rate |
$16,965.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,715.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,768.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,965.52
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$8,997.39
|
|
|
Service Code
|
APR-DRG 3841
|
| Min. Negotiated Rate |
$5,682.56 |
| Max. Negotiated Rate |
$8,997.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,682.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,771.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,997.39
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$29,278.26
|
|
|
Service Code
|
APR-DRG 3844
|
| Min. Negotiated Rate |
$18,491.53 |
| Max. Negotiated Rate |
$29,278.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,491.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,035.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,278.26
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$11,666.19
|
|
|
Service Code
|
APR-DRG 3842
|
| Min. Negotiated Rate |
$7,368.12 |
| Max. Negotiated Rate |
$11,666.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,368.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,780.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,666.19
|
|
|
CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$50,447.00
|
|
|
Service Code
|
CPT 27132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,512.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,245.94
|
| Rate for Payer: EPIC Health Plan Senior |
$18,163.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27,080.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,117.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Prime Health Services Medicare |
$17,503.45
|
| Rate for Payer: Riverside University Health System MISP |
$18,163.96
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$16,512.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION [219718]
|
Facility
|
OP
|
$6,304.32
|
|
|
Service Code
|
HCPCS J9057
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.07 |
| Max. Negotiated Rate |
$5,673.89 |
| Rate for Payer: Adventist Health Commercial |
$1,260.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$170.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,358.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,467.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,728.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$150.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.25
|
| Rate for Payer: Blue Shield of California Commercial |
$115.58
|
| Rate for Payer: Blue Shield of California EPN |
$105.07
|
| Rate for Payer: Cash Price |
$2,836.94
|
| Rate for Payer: Cash Price |
$2,836.94
|
| Rate for Payer: Central Health Plan Commercial |
$5,043.46
|
| Rate for Payer: Cigna of CA HMO |
$4,413.02
|
| Rate for Payer: Cigna of CA PPO |
$4,413.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,358.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,358.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,358.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,413.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,521.73
|
| Rate for Payer: EPIC Health Plan Senior |
$2,521.73
|
| Rate for Payer: Galaxy Health WC |
$5,358.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3,782.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,673.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,003.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,288.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,719.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,413.02
|
| Rate for Payer: Multiplan Commercial |
$4,728.24
|
| Rate for Payer: Networks By Design Commercial |
$3,152.16
|
| Rate for Payer: Prime Health Services Commercial |
$5,358.67
|
| Rate for Payer: Riverside University Health System MISP |
$2,521.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,782.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,782.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,366.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2,302.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,253.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,064.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,358.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,358.67
|
| Rate for Payer: Vantage Medical Group Senior |
$5,358.67
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION [219718]
|
Facility
|
IP
|
$6,304.32
|
|
|
Service Code
|
HCPCS J9057
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,260.86 |
| Max. Negotiated Rate |
$5,673.89 |
| Rate for Payer: Adventist Health Commercial |
$1,260.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5,056.06
|
| Rate for Payer: Blue Shield of California EPN |
$3,177.38
|
| Rate for Payer: Cash Price |
$2,836.94
|
| Rate for Payer: Central Health Plan Commercial |
$5,043.46
|
| Rate for Payer: Cigna of CA HMO |
$4,413.02
|
| Rate for Payer: Cigna of CA PPO |
$4,413.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,413.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,521.73
|
| Rate for Payer: EPIC Health Plan Senior |
$2,521.73
|
| Rate for Payer: Galaxy Health WC |
$5,358.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3,782.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,673.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,003.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,719.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.86
|
| Rate for Payer: Multiplan Commercial |
$4,728.24
|
| Rate for Payer: Networks By Design Commercial |
$3,152.16
|
| Rate for Payer: Prime Health Services Commercial |
$5,358.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,366.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2,302.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,253.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,064.66
|
|
|
COPPER 2 MG (AS GLUCONATE) TABLET [112194]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0536143901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
COPPER 2 MG (AS GLUCONATE) TABLET [112194]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0536143901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
COPPER CHLORIDE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080425]
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.08
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
|
|
COPPER CHLORIDE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080425]
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.08
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Riverside University Health System MISP |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
COPPER SULFATE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080426]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 9994080426
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
COPPER SULFATE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080426]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 9994080426
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$66,897.29
|
|
|
Service Code
|
APR-DRG 1651
|
| Min. Negotiated Rate |
$42,250.92 |
| Max. Negotiated Rate |
$66,897.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$42,250.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50,349.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66,897.29
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$73,276.24
|
|
|
Service Code
|
APR-DRG 1652
|
| Min. Negotiated Rate |
$46,279.73 |
| Max. Negotiated Rate |
$73,276.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$46,279.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55,150.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73,276.24
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$120,952.12
|
|
|
Service Code
|
APR-DRG 1654
|
| Min. Negotiated Rate |
$76,390.81 |
| Max. Negotiated Rate |
$120,952.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$76,390.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91,032.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120,952.12
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$89,170.21
|
|
|
Service Code
|
APR-DRG 1653
|
| Min. Negotiated Rate |
$56,318.03 |
| Max. Negotiated Rate |
$89,170.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$56,318.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67,112.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89,170.21
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC
|
Facility
|
IP
|
$201,214.02
|
|
|
Service Code
|
MSDRG 233
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$201,214.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$201,214.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129,976.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181,971.05
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$175,468.51
|
| Rate for Payer: EPIC Health Plan Senior |
$116,979.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106,344.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148,882.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142,501.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$106,344.55
|
| Rate for Payer: Prime Health Services Medicare |
$112,725.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$143,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$143,136.00
|
| Rate for Payer: United Healthcare HMO Rider |
$80,682.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,919.00
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC
|
Facility
|
IP
|
$143,772.80
|
|
|
Service Code
|
MSDRG 234
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$143,772.80 |
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143,772.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92,871.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130,023.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$125,801.63
|
| Rate for Payer: EPIC Health Plan Senior |
$83,867.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76,243.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106,740.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$102,166.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$76,243.41
|
| Rate for Payer: Prime Health Services Medicare |
$80,818.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$103,054.00
|
| Rate for Payer: United Healthcare All Other HMO |
$103,054.00
|
| Rate for Payer: United Healthcare HMO Rider |
$74,111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67,897.00
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$104,588.82
|
|
|
Service Code
|
APR-DRG 1664
|
| Min. Negotiated Rate |
$66,056.10 |
| Max. Negotiated Rate |
$104,588.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$66,056.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78,716.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104,588.82
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$56,560.47
|
|
|
Service Code
|
APR-DRG 1661
|
| Min. Negotiated Rate |
$35,722.40 |
| Max. Negotiated Rate |
$56,560.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$35,722.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42,569.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56,560.47
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$75,926.91
|
|
|
Service Code
|
APR-DRG 1663
|
| Min. Negotiated Rate |
$47,953.84 |
| Max. Negotiated Rate |
$75,926.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$47,953.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57,144.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75,926.91
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$62,820.57
|
|
|
Service Code
|
APR-DRG 1662
|
| Min. Negotiated Rate |
$39,676.15 |
| Max. Negotiated Rate |
$62,820.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$39,676.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47,280.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62,820.57
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$154,455.68
|
|
|
Service Code
|
MSDRG 235
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$154,455.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154,455.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99,772.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139,684.42
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$135,038.64
|
| Rate for Payer: EPIC Health Plan Senior |
$90,025.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$81,841.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114,578.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109,667.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$81,841.60
|
| Rate for Payer: Prime Health Services Medicare |
$86,752.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$83,791.00
|
| Rate for Payer: United Healthcare All Other HMO |
$83,791.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56,388.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51,660.00
|
|
