|
ANTIVENIN CROTALIDAE (EQUINE) 120 MG SOLUTION FOR INJECTION [222871]
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$316.80 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,270.37
|
| Rate for Payer: Blue Shield of California EPN |
$798.34
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,267.20
|
| Rate for Payer: Cigna of CA HMO |
$1,108.80
|
| Rate for Payer: Cigna of CA PPO |
$1,108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$633.60
|
| Rate for Payer: EPIC Health Plan Senior |
$633.60
|
| Rate for Payer: Galaxy Health WC |
$1,346.40
|
| Rate for Payer: Global Benefits Group Commercial |
$950.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,425.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,005.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$934.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.80
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: Networks By Design Commercial |
$792.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,346.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$594.48
|
| Rate for Payer: United Healthcare All Other HMO |
$578.64
|
| Rate for Payer: United Healthcare HMO Rider |
$566.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.76
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
|
IP
|
$181,019.45
|
|
|
Service Code
|
MSDRG 268
|
| Min. Negotiated Rate |
$25,651.00 |
| Max. Negotiated Rate |
$181,019.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$181,019.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116,931.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163,707.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$158,007.18
|
| Rate for Payer: EPIC Health Plan Senior |
$105,338.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$95,761.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134,066.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128,320.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$95,761.93
|
| Rate for Payer: Prime Health Services Medicare |
$101,507.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$127,168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$127,168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,927.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,806.00
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
|
IP
|
$111,150.40
|
|
|
Service Code
|
MSDRG 269
|
| Min. Negotiated Rate |
$25,651.00 |
| Max. Negotiated Rate |
$111,150.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$111,150.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71,798.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100,520.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,594.50
|
| Rate for Payer: EPIC Health Plan Senior |
$65,063.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,148.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,807.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79,258.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$59,148.18
|
| Rate for Payer: Prime Health Services Medicare |
$62,697.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$79,046.00
|
| Rate for Payer: United Healthcare All Other HMO |
$79,046.00
|
| Rate for Payer: United Healthcare HMO Rider |
$52,792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48,365.00
|
|
|
APIXABAN 2.5 MG TABLET [199666]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089321
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Central Health Plan Commercial |
$5.53
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
|
|
APIXABAN 2.5 MG TABLET [199666]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089321
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.76
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Central Health Plan Commercial |
$5.53
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
| Rate for Payer: Riverside University Health System MISP |
$2.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089470
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Central Health Plan Commercial |
$5.53
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089421
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.76
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Central Health Plan Commercial |
$5.53
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
| Rate for Payer: Riverside University Health System MISP |
$2.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089421
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Central Health Plan Commercial |
$5.53
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089470
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.76
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Central Health Plan Commercial |
$5.53
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
| Rate for Payer: Riverside University Health System MISP |
$2.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089431
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Central Health Plan Commercial |
$5.53
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089431
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.76
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Central Health Plan Commercial |
$5.53
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
| Rate for Payer: Riverside University Health System MISP |
$2.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$16,582.82
|
|
|
Service Code
|
APR-DRG 2331
|
| Min. Negotiated Rate |
$10,473.36 |
| Max. Negotiated Rate |
$16,582.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,473.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,480.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,582.82
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$21,364.51
|
|
|
Service Code
|
APR-DRG 2332
|
| Min. Negotiated Rate |
$13,493.38 |
| Max. Negotiated Rate |
$21,364.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,493.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,079.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,364.51
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$45,822.83
|
|
|
Service Code
|
APR-DRG 2334
|
| Min. Negotiated Rate |
$28,940.74 |
| Max. Negotiated Rate |
$45,822.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$28,940.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34,487.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45,822.83
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$30,396.14
|
|
|
Service Code
|
APR-DRG 2333
|
| Min. Negotiated Rate |
$19,197.56 |
| Max. Negotiated Rate |
$30,396.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,197.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,877.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30,396.14
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$13,424.58
|
|
|
Service Code
|
APR-DRG 2341
|
| Min. Negotiated Rate |
$8,478.68 |
| Max. Negotiated Rate |
$13,424.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,478.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,103.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,424.58
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$41,057.25
|
|
|
Service Code
|
APR-DRG 2344
|
| Min. Negotiated Rate |
$25,930.90 |
| Max. Negotiated Rate |
$41,057.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,930.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30,900.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41,057.25
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$17,124.64
|
|
|
Service Code
|
APR-DRG 2342
|
| Min. Negotiated Rate |
$10,815.56 |
| Max. Negotiated Rate |
$17,124.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,815.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,888.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,124.64
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$25,445.26
|
|
|
Service Code
|
APR-DRG 2343
|
| Min. Negotiated Rate |
$16,070.69 |
| Max. Negotiated Rate |
$25,445.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,070.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,150.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,445.26
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
|
IP
|
$39,836.44
|
|
|
Service Code
|
MSDRG 398
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$39,836.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,836.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,732.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,026.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,932.46
|
| Rate for Payer: EPIC Health Plan Senior |
$23,954.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,777.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,488.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,181.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,777.25
|
| Rate for Payer: Prime Health Services Medicare |
$23,083.88
|
| 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
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
|
IP
|
$63,031.37
|
|
|
Service Code
|
MSDRG 397
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$63,031.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63,031.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40,715.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57,003.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,988.08
|
| Rate for Payer: EPIC Health Plan Senior |
$37,325.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,932.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47,505.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,469.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$33,932.17
|
| Rate for Payer: Prime Health Services Medicare |
$35,968.10
|
| 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
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,127.36
|
|
|
Service Code
|
MSDRG 399
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$30,127.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,127.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,461.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,246.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,537.44
|
| Rate for Payer: EPIC Health Plan Senior |
$18,358.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,689.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,365.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,363.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,689.36
|
| Rate for Payer: Prime Health Services Medicare |
$17,690.72
|
| 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
|
|
|
APPLICATION OF A UNIPLANE (PINS OR WIRES IN 1 PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 20690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$290.08 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| 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 |
$14,462.30
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| 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 |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; EACH ADDITIONAL 100 SQ CM WOUND SURFACE AREA, OR PART THEREOF, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15278
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.12 |
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; FIRST 100 SQ CM WOUND SURFACE AREA, OR 1% OF BODY AREA OF INFANTS AND CHILDREN
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15277
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
