|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$110,245.03
|
|
|
Service Code
|
MSDRG 236
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$110,245.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110,245.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71,213.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99,701.82
|
| 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 |
$96,811.65
|
| Rate for Payer: EPIC Health Plan Senior |
$64,541.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,673.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,143.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78,622.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$58,673.73
|
| Rate for Payer: Prime Health Services Medicare |
$62,194.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$76,448.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76,448.00
|
| Rate for Payer: United Healthcare HMO Rider |
$52,096.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47,726.00
|
|
|
CORONARY BYPASS WITH PTCA WITH MCC
|
Facility
|
IP
|
$221,866.54
|
|
|
Service Code
|
MSDRG 231
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$221,866.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$221,866.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143,316.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200,648.48
|
| 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 |
$193,325.85
|
| Rate for Payer: EPIC Health Plan Senior |
$128,883.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117,167.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164,034.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$157,004.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117,167.18
|
| Rate for Payer: Prime Health Services Medicare |
$124,197.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$107,429.00
|
| Rate for Payer: United Healthcare All Other HMO |
$107,429.00
|
| Rate for Payer: United Healthcare HMO Rider |
$94,080.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86,191.00
|
|
|
CORONARY BYPASS WITH PTCA WITHOUT MCC
|
Facility
|
IP
|
$159,561.57
|
|
|
Service Code
|
MSDRG 232
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$159,561.57 |
| 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 |
$159,561.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103,070.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144,302.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$139,453.50
|
| Rate for Payer: EPIC Health Plan Senior |
$92,969.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$84,517.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118,324.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113,253.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$84,517.27
|
| Rate for Payer: Prime Health Services Medicare |
$89,588.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$94,061.00
|
| Rate for Payer: United Healthcare All Other HMO |
$94,061.00
|
| Rate for Payer: United Healthcare HMO Rider |
$79,841.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,147.00
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$113,892.84
|
|
|
Service Code
|
MSDRG 323
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$113,892.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$113,892.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73,570.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103,000.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$99,965.76
|
| Rate for Payer: EPIC Health Plan Senior |
$66,643.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,585.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,819.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$81,184.32
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60,585.31
|
| Rate for Payer: Prime Health Services Medicare |
$64,220.43
|
| 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
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$82,931.17
|
|
|
Service Code
|
MSDRG 324
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$82,931.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82,931.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53,570.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75,000.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73,194.56
|
| Rate for Payer: EPIC Health Plan Senior |
$48,796.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44,360.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62,104.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$59,442.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$44,360.34
|
| Rate for Payer: Prime Health Services Medicare |
$47,021.96
|
| 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
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$84,494.52
|
|
|
Service Code
|
MSDRG 325
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$84,494.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84,494.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54,580.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76,413.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$74,546.34
|
| Rate for Payer: EPIC Health Plan Senior |
$49,697.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$45,179.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63,251.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60,540.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$45,179.60
|
| Rate for Payer: Prime Health Services Medicare |
$47,890.38
|
| 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
|
|
|
CORONOIDECTOMY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 21070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$145.36 |
| 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 |
$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 |
$11,976.10
|
| 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 |
$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 |
$145.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| 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
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH RESECTION OF PROXIMAL PHALANX BASE, WHEN PERFORMED, ANY METHOD
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 28292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$507.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| 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 |
$6,568.63
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$507.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$348.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| 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 |
$6,568.63
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$348.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
CORRECTION OF LAGOPHTHALMOS, WITH IMPLANTATION OF UPPER EYELID LID LOAD (EG, GOLD WEIGHT)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,451.04 |
| 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 |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| 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 |
$1,451.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,602.90
|
| 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
|
|
|
CORRECTION OF LID RETRACTION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67911
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$140.89 |
| 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 |
$140.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.63
|
| 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
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
|
IP
|
$8,168.16
|
|
|
Service Code
|
HCPCS J0801
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,633.63 |
| Max. Negotiated Rate |
$7,351.34 |
| Rate for Payer: Adventist Health Commercial |
$1,633.63
|
| Rate for Payer: Adventist Health Commercial |
$2,239.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6,550.86
|
| Rate for Payer: Blue Shield of California Commercial |
$8,981.69
|
| Rate for Payer: Blue Shield of California EPN |
$5,644.36
|
| Rate for Payer: Blue Shield of California EPN |
$4,116.75
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cash Price |
$5,039.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,534.53
|
| Rate for Payer: Central Health Plan Commercial |
$8,959.30
|
| Rate for Payer: Cigna of CA HMO |
$7,839.38
|
| Rate for Payer: Cigna of CA HMO |
$5,717.71
|
| Rate for Payer: Cigna of CA PPO |
$7,839.38
|
| Rate for Payer: Cigna of CA PPO |
$5,717.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,839.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,717.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,479.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,267.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4,479.65
|
| Rate for Payer: EPIC Health Plan Senior |
$3,267.26
|
| Rate for Payer: Galaxy Health WC |
$6,942.94
|
| Rate for Payer: Galaxy Health WC |
$9,519.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,719.47
|
| Rate for Payer: Global Benefits Group Commercial |
$4,900.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,079.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,351.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,186.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,111.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,607.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,819.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,239.82
|
| Rate for Payer: Multiplan Commercial |
$8,399.34
|
| Rate for Payer: Multiplan Commercial |
$6,126.12
|
| Rate for Payer: Networks By Design Commercial |
$5,599.56
|
| Rate for Payer: Networks By Design Commercial |
$4,084.08
|
| Rate for Payer: Prime Health Services Commercial |
$6,942.94
|
| Rate for Payer: Prime Health Services Commercial |
$9,519.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,065.51
|
| Rate for Payer: United Healthcare All Other HMO |
$2,983.83
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.04
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2,919.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,667.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,675.07
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
|
OP
|
$8,168.16
|
|
|
Service Code
|
HCPCS J0801
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,633.63 |
| Max. Negotiated Rate |
$24,127.78 |
| Rate for Payer: Adventist Health Commercial |
$1,633.63
|
| Rate for Payer: Adventist Health Commercial |
$2,239.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,133.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,133.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,127.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,127.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,546.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,546.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,133.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,133.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,451.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,451.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,546.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,546.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5,805.85
|
| Rate for Payer: Blue Shield of California Commercial |
$5,805.85
|
| Rate for Payer: Blue Shield of California EPN |
$5,278.05
|
| Rate for Payer: Blue Shield of California EPN |
$5,278.05
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cash Price |
$5,039.60
|
| Rate for Payer: Cash Price |
$5,039.60
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Central Health Plan Commercial |
$6,534.53
|
| Rate for Payer: Central Health Plan Commercial |
$8,959.30
|
| Rate for Payer: Cigna of CA HMO |
$5,717.71
|
| Rate for Payer: Cigna of CA HMO |
$7,839.38
|
| Rate for Payer: Cigna of CA PPO |
$5,717.71
|
| Rate for Payer: Cigna of CA PPO |
$7,839.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,546.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,546.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,133.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,839.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,717.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,820.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,820.19
|
| Rate for Payer: EPIC Health Plan Senior |
$4,546.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,546.80
|
| Rate for Payer: Galaxy Health WC |
$9,519.25
|
| Rate for Payer: Galaxy Health WC |
$6,942.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4,900.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,719.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,079.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,351.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,778.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,778.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,133.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,133.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,133.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,133.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,111.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,186.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,936.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,936.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,786.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,786.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,239.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,538.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,538.82
|
| Rate for Payer: Multiplan Commercial |
$8,399.34
|
| Rate for Payer: Multiplan Commercial |
$6,126.12
|
| Rate for Payer: Networks By Design Commercial |
$5,599.56
|
| Rate for Payer: Networks By Design Commercial |
$4,084.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,133.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,133.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,519.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,942.94
|
| Rate for Payer: Prime Health Services Medicare |
$4,381.46
|
| Rate for Payer: Prime Health Services Medicare |
$4,381.46
|
| Rate for Payer: Riverside University Health System MISP |
$4,546.80
|
| Rate for Payer: Riverside University Health System MISP |
$4,546.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,719.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,900.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,900.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,719.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,065.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.04
|
| Rate for Payer: United Healthcare All Other HMO |
$2,983.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2,919.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,675.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,667.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,133.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,133.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,200.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,546.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,546.80
|
| Rate for Payer: Vantage Medical Group Senior |
$4,133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,133.45
|
|
|
COSIBELIMAB-IPDL 300 MG/5 ML (60 MG/ML) INTRAVENOUS SOLUTION [247041]
|
Facility
|
OP
|
$778.50
|
|
|
Service Code
|
HCPCS J9275
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$700.65 |
| Rate for Payer: Adventist Health Commercial |
$155.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$472.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.47
|
| Rate for Payer: Blue Shield of California Commercial |
$493.57
|
| Rate for Payer: Blue Shield of California EPN |
$310.62
|
| Rate for Payer: Cash Price |
$350.32
|
| Rate for Payer: Cash Price |
$350.32
|
| Rate for Payer: Central Health Plan Commercial |
$622.80
|
| Rate for Payer: Cigna of CA HMO |
$544.95
|
| Rate for Payer: Cigna of CA PPO |
$544.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.75
|
| Rate for Payer: EPIC Health Plan Senior |
$24.50
|
| Rate for Payer: Galaxy Health WC |
$661.73
|
| Rate for Payer: Global Benefits Group Commercial |
$467.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$700.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$282.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$583.88
|
| Rate for Payer: Networks By Design Commercial |
$389.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.27
|
| Rate for Payer: Prime Health Services Commercial |
$661.73
|
| Rate for Payer: Prime Health Services Medicare |
$23.61
|
| Rate for Payer: Riverside University Health System MISP |
$24.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$467.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$467.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.17
|
| Rate for Payer: United Healthcare All Other HMO |
$284.39
|
| Rate for Payer: United Healthcare HMO Rider |
$278.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.50
|
| Rate for Payer: Vantage Medical Group Senior |
$22.27
|
|
|
COSIBELIMAB-IPDL 300 MG/5 ML (60 MG/ML) INTRAVENOUS SOLUTION [247041]
|
Facility
|
IP
|
$778.50
|
|
|
Service Code
|
HCPCS J9275
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.70 |
| Max. Negotiated Rate |
$700.65 |
| Rate for Payer: Adventist Health Commercial |
$155.70
|
| Rate for Payer: Blue Shield of California Commercial |
$624.36
|
| Rate for Payer: Blue Shield of California EPN |
$392.36
|
| Rate for Payer: Cash Price |
$350.32
|
| Rate for Payer: Central Health Plan Commercial |
$622.80
|
| Rate for Payer: Cigna of CA HMO |
$544.95
|
| Rate for Payer: Cigna of CA PPO |
$544.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.40
|
| Rate for Payer: EPIC Health Plan Senior |
$311.40
|
| Rate for Payer: Galaxy Health WC |
$661.73
|
| Rate for Payer: Global Benefits Group Commercial |
$467.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$700.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.70
|
| Rate for Payer: Multiplan Commercial |
$583.88
|
| Rate for Payer: Networks By Design Commercial |
$389.25
|
| Rate for Payer: Prime Health Services Commercial |
$661.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.17
|
| Rate for Payer: United Healthcare All Other HMO |
$284.39
|
| Rate for Payer: United Healthcare HMO Rider |
$278.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.96
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
|
OP
|
$96.24
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$263.16 |
| Rate for Payer: Adventist Health Commercial |
$19.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$206.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$210.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.16
|
| Rate for Payer: Blue Shield of California Commercial |
$105.86
|
| Rate for Payer: Blue Shield of California EPN |
$96.24
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Central Health Plan Commercial |
$76.99
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Senior |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.37
|
| Rate for Payer: Multiplan Commercial |
$72.18
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
| Rate for Payer: Riverside University Health System MISP |
$38.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.12
|
| Rate for Payer: United Healthcare All Other HMO |
$35.16
|
| Rate for Payer: United Healthcare HMO Rider |
$34.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.80
|
| Rate for Payer: Vantage Medical Group Senior |
$81.80
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
|
IP
|
$96.24
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$86.62 |
| Rate for Payer: Adventist Health Commercial |
$19.25
|
| Rate for Payer: Blue Shield of California Commercial |
$77.18
|
| Rate for Payer: Blue Shield of California EPN |
$48.50
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Central Health Plan Commercial |
$76.99
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Senior |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$72.18
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.12
|
| Rate for Payer: United Healthcare All Other HMO |
$35.16
|
| Rate for Payer: United Healthcare HMO Rider |
$34.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.52
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$42,223.57
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$42,223.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,223.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,274.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38,185.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,996.51
|
| Rate for Payer: EPIC Health Plan Senior |
$25,331.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,028.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,239.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,857.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,028.19
|
| Rate for Payer: Prime Health Services Medicare |
$24,409.88
|
| 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
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$27,129.63
|
|
|
Service Code
|
MSDRG 074
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$27,129.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,129.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,524.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,535.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,945.44
|
| Rate for Payer: EPIC Health Plan Senior |
$16,630.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,165.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,258.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15,118.45
|
| Rate for Payer: Prime Health Services Medicare |
$16,025.56
|
| 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
|
|
|
CRANIECTOMY; FOR OSTEOMYELITIS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 61501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.31 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,639.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,810.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$81,831.03
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$81,831.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81,831.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52,859.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74,005.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$72,243.35
|
| Rate for Payer: EPIC Health Plan Senior |
$48,162.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43,783.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61,297.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$58,670.36
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$43,783.85
|
| Rate for Payer: Prime Health Services Medicare |
$46,410.88
|
| 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
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$119,664.60
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$119,664.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119,664.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$77,298.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108,220.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$104,956.35
|
| Rate for Payer: EPIC Health Plan Senior |
$69,970.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,609.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89,053.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$85,237.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$63,609.91
|
| Rate for Payer: Prime Health Services Medicare |
$67,426.50
|
| 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
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$66,400.21
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$66,400.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,400.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42,891.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60,050.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,900.96
|
| Rate for Payer: EPIC Health Plan Senior |
$39,267.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35,697.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49,976.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47,834.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35,697.55
|
| Rate for Payer: Prime Health Services Medicare |
$37,839.40
|
| 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
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$42,930.44
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$27,113.96 |
| Max. Negotiated Rate |
$42,930.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,113.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32,310.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,930.44
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$43,035.19
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$27,180.12 |
| Max. Negotiated Rate |
$43,035.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,180.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32,389.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43,035.19
|
|
