|
TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SINGLE INTERSPACE, CERVICAL
|
Facility
|
OP
|
$37,989.98
|
|
|
Service Code
|
CPT 22856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$423.27 |
| Max. Negotiated Rate |
$37,989.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,551.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,551.42
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$37,230.18
|
| 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 |
$33,827.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,806.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,551.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,209.84
|
| Rate for Payer: EPIC Health Plan Senior |
$24,806.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,984.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$423.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$467.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,571.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,218.90
|
| Rate for Payer: Multiplan WC |
$37,230.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Preferred Health Network WC |
$37,989.98
|
| Rate for Payer: Prime Health Services Medicare |
$23,904.51
|
| Rate for Payer: Prime Health Services WC |
$36,850.28
|
| Rate for Payer: Riverside University Health System MISP |
$24,806.56
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,551.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Vantage Medical Group Senior |
$22,551.42
|
|
|
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 60220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.83 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,775.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| 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 |
$11,811.52
|
| 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 |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$190.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Preferred Health Network WC |
$12,052.57
|
| Rate for Payer: Prime Health Services Medicare |
$8,242.09
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Riverside University Health System MISP |
$8,553.12
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$35,187.90
|
|
|
Service Code
|
APR-DRG 8164
|
| Min. Negotiated Rate |
$22,223.94 |
| Max. Negotiated Rate |
$35,187.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,223.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,483.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35,187.90
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$9,351.88
|
|
|
Service Code
|
APR-DRG 8162
|
| Min. Negotiated Rate |
$5,906.45 |
| Max. Negotiated Rate |
$9,351.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,906.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,038.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,351.88
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$6,521.94
|
|
|
Service Code
|
APR-DRG 8161
|
| Min. Negotiated Rate |
$4,119.12 |
| Max. Negotiated Rate |
$6,521.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,119.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,908.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,521.94
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$17,060.19
|
|
|
Service Code
|
APR-DRG 8163
|
| Min. Negotiated Rate |
$10,774.86 |
| Max. Negotiated Rate |
$17,060.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,774.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,840.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,060.19
|
|
|
TPN NICU NO DOSE REVISED [4082636]
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
NDC 9994081636
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.20
|
| Rate for Payer: Blue Shield of California EPN |
$251.50
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
|
|
TPN NICU NO DOSE REVISED [4082636]
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
NDC 9994081636
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$374.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.27
|
| Rate for Payer: Blue Shield of California Commercial |
$316.37
|
| Rate for Payer: Blue Shield of California EPN |
$199.10
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Cigna of CA HMO |
$319.36
|
| Rate for Payer: Cigna of CA PPO |
$369.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$181.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$349.30
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Riverside University Health System MISP |
$199.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$249.50
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$249.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
TPN: NICU STARTER [196140]
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
NDC 9999196140
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.20
|
| Rate for Payer: Blue Shield of California EPN |
$251.50
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
|
|
TPN: NICU STARTER [196140]
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
NDC 9999196140
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$374.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.27
|
| Rate for Payer: Blue Shield of California Commercial |
$316.37
|
| Rate for Payer: Blue Shield of California EPN |
$199.10
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Cigna of CA HMO |
$319.36
|
| Rate for Payer: Cigna of CA PPO |
$369.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$181.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$349.30
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Riverside University Health System MISP |
$199.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$249.50
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$249.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS POWDER FOR SOLUTION [211543]
|
Facility
|
OP
|
$4,737.11
|
|
|
Service Code
|
HCPCS J9352
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$410.48 |
| Max. Negotiated Rate |
$4,263.40 |
| Rate for Payer: Adventist Health Commercial |
$947.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$410.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,254.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$615.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$410.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$666.88
|
| Rate for Payer: Blue Shield of California Commercial |
$455.14
|
| Rate for Payer: Blue Shield of California EPN |
$413.76
|
| Rate for Payer: Cash Price |
$2,131.70
|
| Rate for Payer: Cash Price |
$2,131.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,789.69
|
| Rate for Payer: Cigna of CA HMO |
$3,315.98
|
| Rate for Payer: Cigna of CA PPO |
$3,315.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$513.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$451.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$451.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,315.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$677.29
|
| Rate for Payer: EPIC Health Plan Senior |
$451.53
|
| Rate for Payer: Galaxy Health WC |
$4,026.54
|
| Rate for Payer: Global Benefits Group Commercial |
$2,842.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,263.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$673.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$410.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$410.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,008.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$743.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$574.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$550.04
|
| Rate for Payer: Multiplan Commercial |
$3,552.83
|
| Rate for Payer: Networks By Design Commercial |
$2,368.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$4,026.54
|
| Rate for Payer: Prime Health Services Medicare |
$435.11
|
| Rate for Payer: Riverside University Health System MISP |
$451.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,842.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,842.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,777.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,730.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,693.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,551.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$410.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$513.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$451.53
|
| Rate for Payer: Vantage Medical Group Senior |
$451.53
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS POWDER FOR SOLUTION [211543]
|
Facility
|
IP
|
$4,737.11
|
|
|
Service Code
|
HCPCS J9352
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$947.42 |
| Max. Negotiated Rate |
$4,263.40 |
| Rate for Payer: Adventist Health Commercial |
$947.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,799.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,387.50
|
| Rate for Payer: Cash Price |
$2,131.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,789.69
|
| Rate for Payer: Cigna of CA HMO |
$3,315.98
|
| Rate for Payer: Cigna of CA PPO |
$3,315.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,315.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,894.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1,894.84
|
| Rate for Payer: Galaxy Health WC |
$4,026.54
|
| Rate for Payer: Global Benefits Group Commercial |
$2,842.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,263.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,008.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,794.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.42
|
| Rate for Payer: Multiplan Commercial |
$3,552.83
|
| Rate for Payer: Networks By Design Commercial |
$2,368.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,026.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,777.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,730.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,693.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,551.40
|
|
|
TRACE ELEMENT PEDI CR-CU-MN-ZN 1 MCG-0.1 MG-25 MCG-1 MG/ML INTRAVENOUS [18266]
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Central Health Plan Commercial |
$3.89
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Senior |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.65
|
| Rate for Payer: Networks By Design Commercial |
$2.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.59
|
|
|
TRACE ELEMENT PEDI CR-CU-MN-ZN 1 MCG-0.1 MG-25 MCG-1 MG/ML INTRAVENOUS [18266]
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Central Health Plan Commercial |
$3.89
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Senior |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$3.65
|
| Rate for Payer: Networks By Design Commercial |
$2.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
| Rate for Payer: Riverside University Health System MISP |
$1.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.13
|
| Rate for Payer: Vantage Medical Group Senior |
$4.13
|
|
|
TRACE ELEMENTS CHOLESTASIS [4080051]
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$4.41
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$4.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Riverside University Health System MISP |
$2.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
TRACE ELEMENTS CHOLESTASIS [4080051]
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$5.04
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$4.41
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$4.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
|
|
TRACE ELEMENTS FULL TERM [4080053]
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.05
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$4.41
|
| Rate for Payer: Cigna of CA PPO |
$4.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
|
|
TRACE ELEMENTS FULL TERM [4080053]
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$4.41
|
| Rate for Payer: Cigna of CA PPO |
$4.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Riverside University Health System MISP |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
TRACE ELEMENTS PRETERM [4080052]
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$4.41
|
| Rate for Payer: Cigna of CA PPO |
$4.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Riverside University Health System MISP |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
TRACE ELEMENTS PRETERM [4080052]
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.05
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$4.41
|
| Rate for Payer: Cigna of CA PPO |
$4.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
|
|
TRACHEOSTOMA REVISION; COMPLEX, WITH FLAP ROTATION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31614
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$544.31 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| 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 |
$11,976.10
|
| 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 |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$544.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$601.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| 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 |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
TRACHEOSTOMA REVISION; SIMPLE, WITHOUT FLAP ROTATION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31613
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.78 |
| Max. Negotiated Rate |
$27,467.00 |
| 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 |
$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 |
$6,565.51
|
| 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 |
$6,396.35
|
| 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 |
$386.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.25
|
| 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: Upland Medical Group Pediatric |
$4,264.23
|
| 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
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC
|
Facility
|
IP
|
$110,960.90
|
|
|
Service Code
|
MSDRG 012
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$110,960.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110,960.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71,676.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100,349.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,430.65
|
| Rate for Payer: EPIC Health Plan Senior |
$64,953.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,048.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,668.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79,125.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$59,048.88
|
| Rate for Payer: Prime Health Services Medicare |
$62,591.81
|
| 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
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC
|
Facility
|
IP
|
$143,546.46
|
|
|
Service Code
|
MSDRG 011
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$143,546.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$143,546.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92,725.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129,818.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$125,605.94
|
| Rate for Payer: EPIC Health Plan Senior |
$83,737.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76,124.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106,574.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$102,007.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$76,124.81
|
| Rate for Payer: Prime Health Services Medicare |
$80,692.30
|
| 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
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$75,846.09
|
|
|
Service Code
|
MSDRG 013
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$75,846.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75,846.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48,993.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68,592.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67,068.42
|
| Rate for Payer: EPIC Health Plan Senior |
$44,712.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,647.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56,906.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,467.69
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$40,647.53
|
| Rate for Payer: Prime Health Services Medicare |
$43,086.38
|
| 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
|
|
