|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$35,646.02
|
|
|
Service Code
|
MSDRG 475
|
| Min. Negotiated Rate |
$26,601.51 |
| Max. Negotiated Rate |
$35,646.02 |
| Rate for Payer: EPIC Health Plan Medicare |
$26,601.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,601.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,591.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,646.02
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$66,621.09
|
|
|
Service Code
|
MSDRG 474
|
| Min. Negotiated Rate |
$49,717.23 |
| Max. Negotiated Rate |
$66,621.09 |
| Rate for Payer: EPIC Health Plan Medicare |
$49,717.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49,717.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57,174.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$66,621.09
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,824.11
|
|
|
Service Code
|
MSDRG 476
|
| Min. Negotiated Rate |
$14,047.84 |
| Max. Negotiated Rate |
$18,824.11 |
| Rate for Payer: EPIC Health Plan Medicare |
$14,047.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,047.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,155.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,824.11
|
|
|
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; RE-AMPUTATION
|
Facility
|
OP
|
$14,160.00
|
|
|
Service Code
|
CPT 27886
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,208.34 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,176.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,995.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,629.17
|
| Rate for Payer: TriValley Medical Group Senior |
$4,629.17
|
| 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 |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
AMPUTATION, METATARSAL, WITH TOE, SINGLE
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 28810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,208.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,176.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,995.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,629.17
|
| Rate for Payer: TriValley Medical Group Senior |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$29,420.92
|
|
|
Service Code
|
MSDRG 617
|
| Min. Negotiated Rate |
$21,955.91 |
| Max. Negotiated Rate |
$29,420.92 |
| Rate for Payer: EPIC Health Plan Medicare |
$21,955.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,955.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25,249.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,420.92
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$54,252.25
|
|
|
Service Code
|
MSDRG 616
|
| Min. Negotiated Rate |
$40,486.75 |
| Max. Negotiated Rate |
$54,252.25 |
| Rate for Payer: EPIC Health Plan Medicare |
$40,486.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,486.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,559.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,252.25
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,480.27
|
|
|
Service Code
|
MSDRG 618
|
| Min. Negotiated Rate |
$16,776.32 |
| Max. Negotiated Rate |
$22,480.27 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,776.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,776.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,292.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,480.27
|
|
|
AMPUTATION, TOE; INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 28825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,208.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,176.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,995.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,629.17
|
| Rate for Payer: TriValley Medical Group Senior |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,208.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,176.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,995.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,629.17
|
| Rate for Payer: TriValley Medical Group Senior |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 1366845301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.64
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 1366845301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
OP
|
$403.76
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$343.20 |
| Rate for Payer: Adventist Health Commercial |
$80.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$302.82
|
| Rate for Payer: Blue Shield of California Commercial |
$246.29
|
| Rate for Payer: Blue Shield of California EPN |
$197.03
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$185.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.94
|
| Rate for Payer: Heritage Provider Network Senior |
$186.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$192.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$282.63
|
| Rate for Payer: Multiplan Commercial |
$302.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$161.50
|
| Rate for Payer: TriValley Medical Group Senior |
$161.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$145.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$133.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.20
|
| Rate for Payer: Vantage Medical Group Senior |
$343.20
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
IP
|
$403.76
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$302.82 |
| Rate for Payer: Adventist Health Commercial |
$80.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$260.02
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$185.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.94
|
| Rate for Payer: Heritage Provider Network Senior |
$186.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.94
|
| Rate for Payer: Multiplan Commercial |
$302.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$145.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$133.68
|
|
|
ANAL AND STOMAL PROCEDURES WITH CC
|
Facility
|
IP
|
$20,798.85
|
|
|
Service Code
|
MSDRG 348
|
| Min. Negotiated Rate |
$15,521.53 |
| Max. Negotiated Rate |
$20,798.85 |
| Rate for Payer: EPIC Health Plan Medicare |
$15,521.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,521.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,849.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,798.85
|
|
|
ANAL AND STOMAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$35,951.60
|
|
|
Service Code
|
MSDRG 347
|
| Min. Negotiated Rate |
$26,829.55 |
| Max. Negotiated Rate |
$35,951.60 |
| Rate for Payer: EPIC Health Plan Medicare |
$26,829.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,829.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,853.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,951.60
|
|
|
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,070.05
|
|
|
Service Code
|
MSDRG 349
|
| Min. Negotiated Rate |
$10,500.04 |
| Max. Negotiated Rate |
$14,070.05 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,500.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,500.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,075.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,070.05
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.70
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$41.64 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ANGINA PECTORIS
|
Facility
|
IP
|
$11,479.58
|
|
|
Service Code
|
MSDRG 311
|
| Min. Negotiated Rate |
$8,566.85 |
| Max. Negotiated Rate |
$11,479.58 |
| Rate for Payer: EPIC Health Plan Medicare |
$8,566.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,566.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,851.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,479.58
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
|
IP
|
$2,278.80
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$412.46 |
| Max. Negotiated Rate |
$1,709.10 |
| Rate for Payer: Adventist Health Commercial |
$455.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,467.55
|
| Rate for Payer: Cash Price |
$1,025.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,048.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,230.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,055.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,055.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$412.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.70
|
| Rate for Payer: Multiplan Commercial |
$1,709.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$823.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$754.51
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
|
OP
|
$2,278.80
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$412.46 |
| Max. Negotiated Rate |
$1,936.98 |
| Rate for Payer: Adventist Health Commercial |
$455.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,408.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,936.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,253.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,709.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,139.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,390.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,112.05
|
| Rate for Payer: Cash Price |
$1,025.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,048.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,936.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,936.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,936.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,458.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,055.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,055.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,086.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$412.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,595.16
|
| Rate for Payer: Multiplan Commercial |
$1,709.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$911.52
|
| Rate for Payer: TriValley Medical Group Senior |
$911.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$823.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$754.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,936.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,936.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,936.98
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
OP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$141.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.95
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$194.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.06
|
| Rate for Payer: Heritage Provider Network Senior |
$106.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$109.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$160.35
|
| Rate for Payer: Multiplan Commercial |
$171.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$91.63
|
| Rate for Payer: TriValley Medical Group Senior |
$91.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$82.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$75.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.71
|
| Rate for Payer: Vantage Medical Group Senior |
$194.71
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
IP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$171.80 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.52
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.06
|
| Rate for Payer: Heritage Provider Network Senior |
$106.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.27
|
| Rate for Payer: Multiplan Commercial |
$171.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$82.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$75.85
|
|
|
ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$14,160.00
|
|
|
Service Code
|
CPT 22845
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$14,160.00 |
| 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: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
|
