|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC
|
Facility
|
IP
|
$15,688.55
|
|
|
Service Code
|
MSDRG 178
|
| Min. Negotiated Rate |
$11,707.87 |
| Max. Negotiated Rate |
$15,688.55 |
| Rate for Payer: EPIC Health Plan Medicare |
$11,707.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,707.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,464.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,688.55
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC
|
Facility
|
IP
|
$24,697.57
|
|
|
Service Code
|
MSDRG 177
|
| Min. Negotiated Rate |
$18,431.02 |
| Max. Negotiated Rate |
$24,697.57 |
| Rate for Payer: EPIC Health Plan Medicare |
$18,431.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,431.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,195.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24,697.57
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,294.96
|
|
|
Service Code
|
MSDRG 179
|
| Min. Negotiated Rate |
$9,175.34 |
| Max. Negotiated Rate |
$12,294.96 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,175.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,175.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,551.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,294.96
|
|
|
RESPIRATORY NEOPLASMS WITH CC
|
Facility
|
IP
|
$17,147.28
|
|
|
Service Code
|
MSDRG 181
|
| Min. Negotiated Rate |
$12,796.48 |
| Max. Negotiated Rate |
$17,147.28 |
| Rate for Payer: EPIC Health Plan Medicare |
$12,796.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,796.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,715.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,147.28
|
|
|
RESPIRATORY NEOPLASMS WITH MCC
|
Facility
|
IP
|
$27,819.35
|
|
|
Service Code
|
MSDRG 180
|
| Min. Negotiated Rate |
$20,760.71 |
| Max. Negotiated Rate |
$27,819.35 |
| Rate for Payer: EPIC Health Plan Medicare |
$20,760.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,760.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,874.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,819.35
|
|
|
RESPIRATORY NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,276.53
|
|
|
Service Code
|
MSDRG 182
|
| Min. Negotiated Rate |
$9,161.59 |
| Max. Negotiated Rate |
$12,276.53 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,161.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,161.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,535.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,276.53
|
|
|
RESPIRATORY SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$13,099.61
|
|
|
Service Code
|
MSDRG 204
|
| Min. Negotiated Rate |
$9,775.83 |
| Max. Negotiated Rate |
$13,099.61 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,775.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,775.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,242.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,099.61
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS
|
Facility
|
IP
|
$42,909.16
|
|
|
Service Code
|
MSDRG 208
|
| Min. Negotiated Rate |
$32,021.76 |
| Max. Negotiated Rate |
$42,909.16 |
| Rate for Payer: EPIC Health Plan Medicare |
$32,021.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,021.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36,825.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42,909.16
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$99,509.42
|
|
|
Service Code
|
MSDRG 207
|
| Min. Negotiated Rate |
$74,260.76 |
| Max. Negotiated Rate |
$99,509.42 |
| Rate for Payer: EPIC Health Plan Medicare |
$74,260.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74,260.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85,399.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$99,509.42
|
|
|
RESP ONLY: HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION 30 ML [40810176]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
RESP ONLY: HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION 30 ML [40810176]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC
|
Facility
|
IP
|
$16,272.02
|
|
|
Service Code
|
MSDRG 815
|
| Min. Negotiated Rate |
$12,143.30 |
| Max. Negotiated Rate |
$16,272.02 |
| Rate for Payer: EPIC Health Plan Medicare |
$12,143.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,143.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,964.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,272.02
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC
|
Facility
|
IP
|
$33,358.07
|
|
|
Service Code
|
MSDRG 814
|
| Min. Negotiated Rate |
$24,894.08 |
| Max. Negotiated Rate |
$33,358.07 |
| Rate for Payer: EPIC Health Plan Medicare |
$24,894.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,894.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,628.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,358.07
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,406.24
|
|
|
Service Code
|
MSDRG 816
|
| Min. Negotiated Rate |
$7,765.85 |
| Max. Negotiated Rate |
$10,406.24 |
| Rate for Payer: EPIC Health Plan Medicare |
$7,765.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,765.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,930.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,406.24
|
|
|
RETIFANLIMAB-DLWR 500 MG/20 ML INTRAVENOUS SOLUTION [237494]
|
Facility
|
IP
|
$902.28
|
|
|
Service Code
|
HCPCS J9345
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.31 |
| Max. Negotiated Rate |
$676.71 |
| Rate for Payer: Adventist Health Commercial |
$180.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$581.07
|
| Rate for Payer: Cash Price |
$406.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$487.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.76
|
| Rate for Payer: Heritage Provider Network Senior |
$417.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.57
|
| Rate for Payer: Multiplan Commercial |
$676.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$298.74
|
|
|
RETIFANLIMAB-DLWR 500 MG/20 ML INTRAVENOUS SOLUTION [237494]
|
Facility
|
OP
|
$902.28
|
|
|
Service Code
|
HCPCS J9345
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$676.71 |
| Rate for Payer: Adventist Health Commercial |
$180.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.98
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$29.49
|
| Rate for Payer: Cash Price |
$406.03
|
| Rate for Payer: Cash Price |
$406.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$577.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$30.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.76
|
| Rate for Payer: Heritage Provider Network Senior |
$417.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$430.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$676.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$360.91
|
| Rate for Payer: TriValley Medical Group Senior |
$360.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$298.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$34.08
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH CC
|
Facility
|
IP
|
$54,854.19
|
|
|
Service Code
|
MSDRG 467
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$54,854.19 |
| Rate for Payer: EPIC Health Plan Medicare |
$40,935.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,935.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,944.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47,076.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,854.19
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$80,632.95
|
|
|
Service Code
|
MSDRG 466
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$80,632.95 |
| Rate for Payer: EPIC Health Plan Medicare |
$60,173.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,173.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,944.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69,199.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80,632.95
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$42,898.41
|
|
|
Service Code
|
MSDRG 468
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$42,898.41 |
| Rate for Payer: EPIC Health Plan Medicare |
$32,013.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,013.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,944.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36,815.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42,898.41
|
|
|
REVISION OF RECONSTRUCTED BREAST (EG, SIGNIFICANT REMOVAL OF TISSUE, RE-ADVANCEMENT AND/OR RE-INSET OF FLAPS IN AUTOLOGOUS RECONSTRUCTION OR SIGNIFICANT CAPSULAR REVISION COMBINED WITH SOFT TISSUE EXCISION IN IMPLANT-BASED RECONSTRUCTION)
|
Facility
|
OP
|
$16,226.70
|
|
|
Service Code
|
CPT 19380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$16,226.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,394.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,540.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| 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 |
$12,810.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,394.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,540.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,540.37
|
| Rate for Payer: Heritage Provider Network Senior |
$10,504.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,540.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16,226.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,821.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,444.10
|
| Rate for Payer: Multiplan WC |
$13,202.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,394.41
|
| Rate for Payer: TriValley Medical Group Senior |
$9,394.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,394.41
|
| Rate for Payer: Vantage Medical Group Senior |
$8,540.37
|
|
|
REVISION OF TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$24,769.03
|
|
|
Service Code
|
CPT 27134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$24,769.03 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| 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 |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,512.69
|
| Rate for Payer: Heritage Provider Network Senior |
$20,310.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,944.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,989.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,163.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18,163.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; 1 COMPONENT
|
Facility
|
OP
|
$24,769.03
|
|
|
Service Code
|
CPT 27486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$24,769.03 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| 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 |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,512.69
|
| Rate for Payer: Heritage Provider Network Senior |
$20,310.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,944.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,989.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,163.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18,163.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIBIAL COMPONENT
|
Facility
|
OP
|
$33,827.13
|
|
|
Service Code
|
CPT 27487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$33,827.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,551.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| 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 |
$33,827.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,806.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,551.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,551.42
|
| Rate for Payer: Heritage Provider Network Senior |
$27,738.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,944.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25,934.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,218.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,806.56
|
| Rate for Payer: TriValley Medical Group Senior |
$24,806.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Vantage Medical Group Senior |
$22,551.42
|
|
|
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$14,160.00
|
|
|
Service Code
|
CPT 36832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,156.86 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Senior |
$8,802.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,598.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,872.55
|
| Rate for Payer: TriValley Medical Group Senior |
$7,872.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$10,001.00
|
|
|
Service Code
|
CPT 63688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,496.58
|
| 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 |
$6,744.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,946.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,496.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,496.58
|
| Rate for Payer: Heritage Provider Network Senior |
$5,530.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,496.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,543.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,171.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,025.42
|
| Rate for Payer: Multiplan WC |
$6,962.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,946.24
|
| Rate for Payer: TriValley Medical Group Senior |
$4,946.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4,496.58
|
|
