|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$13,157.96
|
|
|
Service Code
|
MSDRG 728
|
| Min. Negotiated Rate |
$9,819.37 |
| Max. Negotiated Rate |
$13,157.96 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,819.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,819.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,292.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,157.96
|
|
|
INFLAMMATORY BOWEL DISEASE WITH CC
|
Facility
|
IP
|
$15,693.14
|
|
|
Service Code
|
MSDRG 386
|
| Min. Negotiated Rate |
$11,711.30 |
| Max. Negotiated Rate |
$15,693.14 |
| Rate for Payer: EPIC Health Plan Medicare |
$11,711.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,711.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,693.14
|
|
|
INFLAMMATORY BOWEL DISEASE WITH MCC
|
Facility
|
IP
|
$24,998.57
|
|
|
Service Code
|
MSDRG 385
|
| Min. Negotiated Rate |
$18,655.65 |
| Max. Negotiated Rate |
$24,998.57 |
| Rate for Payer: EPIC Health Plan Medicare |
$18,655.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,655.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,454.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24,998.57
|
|
|
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$11,163.26
|
|
|
Service Code
|
MSDRG 387
|
| Min. Negotiated Rate |
$8,330.79 |
| Max. Negotiated Rate |
$11,163.26 |
| Rate for Payer: EPIC Health Plan Medicare |
$8,330.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,330.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,580.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,163.26
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.08
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$262.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$263.91
|
| Rate for Payer: Heritage Provider Network Senior |
$263.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$205.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.73
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.48 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$352.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.08
|
| Rate for Payer: Blue Shield of California Commercial |
$48.45
|
| Rate for Payer: Blue Shield of California EPN |
$48.45
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$262.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$263.91
|
| Rate for Payer: Heritage Provider Network Senior |
$263.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$271.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.18
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$228.00
|
| Rate for Payer: TriValley Medical Group Senior |
$228.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$205.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.63
|
| Rate for Payer: Vantage Medical Group Senior |
$34.63
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
|
OP
|
$904.07
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.62 |
| Max. Negotiated Rate |
$678.05 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$558.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.58
|
| Rate for Payer: Blue Shield of California Commercial |
$76.85
|
| Rate for Payer: Blue Shield of California EPN |
$76.85
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$578.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.58
|
| Rate for Payer: Heritage Provider Network Senior |
$418.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$431.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.67
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$361.63
|
| Rate for Payer: TriValley Medical Group Senior |
$361.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$326.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$299.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
|
IP
|
$904.07
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.64 |
| Max. Negotiated Rate |
$678.05 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$582.22
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.58
|
| Rate for Payer: Heritage Provider Network Senior |
$418.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.02
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$326.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$299.34
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [216056]
|
Facility
|
IP
|
$1,135.54
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.53 |
| Max. Negotiated Rate |
$851.65 |
| Rate for Payer: Adventist Health Commercial |
$227.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$731.29
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$522.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.76
|
| Rate for Payer: Heritage Provider Network Senior |
$525.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.88
|
| Rate for Payer: Multiplan Commercial |
$851.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$410.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$375.98
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [216056]
|
Facility
|
OP
|
$1,135.54
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$851.65 |
| Rate for Payer: Adventist Health Commercial |
$227.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$701.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.40
|
| Rate for Payer: Blue Shield of California Commercial |
$96.52
|
| Rate for Payer: Blue Shield of California EPN |
$96.52
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$522.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.76
|
| Rate for Payer: Heritage Provider Network Senior |
$525.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$541.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.13
|
| Rate for Payer: Multiplan Commercial |
$851.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$454.22
|
| Rate for Payer: TriValley Medical Group Senior |
$454.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$410.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$375.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.48
|
| Rate for Payer: Vantage Medical Group Senior |
$30.48
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC
|
Facility
|
IP
|
$24,111.01
|
|
|
Service Code
|
MSDRG 351
|
| Min. Negotiated Rate |
$17,993.29 |
| Max. Negotiated Rate |
$24,111.01 |
| Rate for Payer: EPIC Health Plan Medicare |
$17,993.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,993.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,692.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24,111.01
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC
|
Facility
|
IP
|
$38,965.90
|
|
|
Service Code
|
MSDRG 350
|
| Min. Negotiated Rate |
$29,079.03 |
| Max. Negotiated Rate |
$38,965.90 |
| Rate for Payer: EPIC Health Plan Medicare |
$29,079.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,079.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,440.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,965.90
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,633.69
|
|
|
Service Code
|
MSDRG 352
|
| Min. Negotiated Rate |
$13,905.74 |
| Max. Negotiated Rate |
$18,633.69 |
| Rate for Payer: EPIC Health Plan Medicare |
$13,905.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,905.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,991.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,633.69
|
|
|
INITIAL OPEN IMPLANTATION OF BAROREFLEX ACTIVATION THERAPY (BAT) MODULATION SYSTEM, INCLUDING LEAD PLACEMENT ONTO THE CAROTID SINUS, LEAD TUNNELLING, CONNECTION TO A PULSE GENERATOR PLACED IN A DISTANT SUBCUTANEOUS POCKET (IE, TOTAL SYSTEM), AND INTRAOPERATIVE INTERROGATION AND PROGRAMMING
|
Facility
|
OP
|
$107,637.15
|
|
|
Service Code
|
CPT 64654
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$107,637.15 |
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84,976.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,316.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56,651.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84,976.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$62,316.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56,651.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$56,651.13
|
| Rate for Payer: Heritage Provider Network Senior |
$69,680.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,651.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$107,637.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65,148.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75,912.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$62,316.24
|
| Rate for Payer: TriValley Medical Group Senior |
$62,316.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84,976.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62,316.24
|
| Rate for Payer: Vantage Medical Group Senior |
$56,651.13
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC INITIAL DAY
|
Facility
|
OP
|
$2,847.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.31 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$569.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,759.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,281.15
|
| Rate for Payer: Cash Price |
$1,281.15
|
| Rate for Payer: Cash Price |
$1,281.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,850.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$806.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,762.29
|
| Rate for Payer: Heritage Provider Network Senior |
$992.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,532.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$515.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$711.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,135.25
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$887.50
|
| Rate for Payer: TriValley Medical Group Senior |
$887.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC INITIAL DAY
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.31 |
| Max. Negotiated Rate |
$2,135.25 |
| Rate for Payer: Adventist Health Commercial |
$569.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,833.47
|
| Rate for Payer: Cash Price |
$1,281.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,927.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,927.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$515.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$711.75
|
| Rate for Payer: Multiplan Commercial |
$2,135.25
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC SUB DAY
|
Facility
|
IP
|
$2,998.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.64 |
| Max. Negotiated Rate |
$2,248.50 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,930.71
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,029.65
|
| Rate for Payer: Heritage Provider Network Senior |
$2,029.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.50
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC SUB DAY
|
Facility
|
OP
|
$2,998.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,852.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,948.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$806.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.76
|
| Rate for Payer: Heritage Provider Network Senior |
$992.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,532.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$887.50
|
| Rate for Payer: TriValley Medical Group Senior |
$887.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
INJECTION PROCEDURE FOR ANTEGRADE NEPHROSTOGRAM AND/OR URETEROGRAM, COMPLETE DIAGNOSTIC PROCEDURE INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; EXISTING ACCESS
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 50431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$896.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$896.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,103.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,704.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,031.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,201.77
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$986.52
|
| Rate for Payer: TriValley Medical Group Senior |
$986.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
|
INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT G0260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$907.88 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT 64415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,137.58 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT 64447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$907.88 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT 64450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$907.88 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT 64445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$907.88 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT 62320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$907.88 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
