|
Total Hip Replacement - #2641
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH60CZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
Total Hip Replacement - #2641
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 0JH805Z
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
Total Hip Replacement - #2641
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 0JH605Z
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
Total Hip Replacement - #2641
|
Facility
IP
|
$41,843.00
|
|
|
Service Code
|
ICD 02QA4ZZ
|
| Min. Negotiated Rate |
$41,843.00 |
| Max. Negotiated Rate |
$41,843.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,843.00
|
|
|
Total thyroid lobectomy, unilateral; with or without isthmusectomy
|
Facility
OP
|
$11,823.10
|
|
|
Service Code
|
CPT 60220
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$11,823.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,823.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,823.10
|
| Rate for Payer: IEHP Medi-Cal |
$11,678.92
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,678.92
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
IP
|
$8,656.27
|
|
|
Service Code
|
APR-DRG 8162
|
| Min. Negotiated Rate |
$6,640.27 |
| Max. Negotiated Rate |
$8,656.27 |
| Rate for Payer: IEHP Medi-Cal |
$6,640.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,656.27
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
IP
|
$8,175.64
|
|
|
Service Code
|
APR-DRG 8161
|
| Min. Negotiated Rate |
$6,271.58 |
| Max. Negotiated Rate |
$8,175.64 |
| Rate for Payer: IEHP Medi-Cal |
$6,271.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,175.64
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
IP
|
$20,646.62
|
|
|
Service Code
|
APR-DRG 8164
|
| Min. Negotiated Rate |
$15,838.13 |
| Max. Negotiated Rate |
$20,646.62 |
| Rate for Payer: IEHP Medi-Cal |
$15,838.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,646.62
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
IP
|
$11,440.58
|
|
|
Service Code
|
APR-DRG 8163
|
| Min. Negotiated Rate |
$8,776.13 |
| Max. Negotiated Rate |
$11,440.58 |
| Rate for Payer: IEHP Medi-Cal |
$8,776.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,440.58
|
|
|
TPN NICU NO DOSE REVISED [4082636]
|
Facility
IP
|
$499.00
|
|
|
Service Code
|
NDC 9994-0816-36
|
| Hospital Charge Code |
NDG4082636
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$424.15 |
| Rate for Payer: Blue Shield of California Commercial |
$355.29
|
| Rate for Payer: Blue Shield of California EPN |
$255.49
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
|
|
TPN NICU NO DOSE REVISED [4082636]
|
Facility
OP
|
$499.00
|
|
|
Service Code
|
NDC 9994-0816-36
|
| Hospital Charge Code |
NDG4082636
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$424.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$327.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$274.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$297.30
|
| Rate for Payer: BCBS Transplant Transplant |
$299.40
|
| Rate for Payer: Blue Shield of California Commercial |
$367.76
|
| Rate for Payer: Blue Shield of California EPN |
$291.42
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cigna of CA HMO |
$319.36
|
| Rate for Payer: Cigna of CA PPO |
$369.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Media |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$374.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$249.50
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$249.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
TPN: NICU STARTER [196140]
|
Facility
IP
|
$499.00
|
|
|
Service Code
|
NDC 9999-1961-40
|
| Hospital Charge Code |
NDC196140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$424.15 |
| Rate for Payer: Blue Shield of California Commercial |
$355.29
|
| Rate for Payer: Blue Shield of California EPN |
$255.49
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
|
|
TPN: NICU STARTER [196140]
|
Facility
OP
|
$499.00
|
|
|
Service Code
|
NDC 9999-1961-40
|
| Hospital Charge Code |
NDC196140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$424.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$327.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$274.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$297.30
|
| Rate for Payer: BCBS Transplant Transplant |
$299.40
|
| Rate for Payer: Blue Shield of California Commercial |
$367.76
|
| Rate for Payer: Blue Shield of California EPN |
$291.42
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cigna of CA HMO |
$319.36
|
| Rate for Payer: Cigna of CA PPO |
$369.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Media |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$374.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$249.50
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$249.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS SOLUTION [211543]
|
Facility
IP
|
$3,866.89
|
|
|
Service Code
|
CPT J9352
|
| Hospital Charge Code |
ERX211543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$928.05 |
| Max. Negotiated Rate |
$3,286.86 |
| Rate for Payer: Blue Shield of California Commercial |
$2,753.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,979.85
|
| Rate for Payer: Cash Price |
$1,740.10
|
| Rate for Payer: Cigna of CA HMO |
$2,706.82
|
| Rate for Payer: Cigna of CA PPO |
$2,706.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,546.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,546.76
|
| Rate for Payer: Galaxy Health WC |
$3,286.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2,320.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,579.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,473.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.05
|
| Rate for Payer: Multiplan Commercial |
$3,093.51
|
| Rate for Payer: Networks By Design Commercial |
$1,933.44
|
| Rate for Payer: Prime Health Services Commercial |
$3,286.86
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS SOLUTION [211543]
|
Facility
OP
|
$3,866.89
|
|
|
Service Code
|
CPT J9352
|
| Hospital Charge Code |
ERX211543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.40 |
| Max. Negotiated Rate |
$3,286.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,128.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$423.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$372.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$372.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$575.54
|
| Rate for Payer: BCBS Transplant Transplant |
$2,320.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,849.90
|
| Rate for Payer: Blue Shield of California EPN |
$364.39
|
| Rate for Payer: Cash Price |
$1,740.10
|
| Rate for Payer: Cash Price |
$1,740.10
|
| Rate for Payer: Cigna of CA HMO |
$2,706.82
|
| Rate for Payer: Cigna of CA PPO |
$2,706.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$507.60
|
| Rate for Payer: Dignity Health Media |
$338.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$372.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$338.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$3,286.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2,320.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,900.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$554.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$554.97
|
| Rate for Payer: IEHP Medi-Cal |
$548.21
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$548.21
|
| Rate for Payer: IEHP Medicare Advantage |
$338.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,579.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$651.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$338.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$426.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$453.45
|
| Rate for Payer: Multiplan Commercial |
$3,093.51
|
| Rate for Payer: Networks By Design Commercial |
$1,933.44
|
| Rate for Payer: Prime Health Services Commercial |
$3,286.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,320.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,320.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,933.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,933.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,933.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,933.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$507.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$372.24
|
| Rate for Payer: Vantage Medical Group Senior |
$338.40
|
|
|
TRACE ELEMENT PEDI CR-CU-MN-ZN 1 MCG-0.1 MG-25 MCG-1 MG/ML INTRAVENOUS [18266]
|
Facility
OP
|
$4.86
|
|
|
Service Code
|
NDC 0517-9203-25
|
| Hospital Charge Code |
NDG18266
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.90
|
| Rate for Payer: BCBS Transplant Transplant |
$2.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3.58
|
| Rate for Payer: Blue Shield of California EPN |
$2.84
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna of CA HMO |
$3.11
|
| Rate for Payer: Cigna of CA PPO |
$3.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.13
|
| Rate for Payer: Dignity Health Media |
$4.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Networks By Design Commercial |
$3.16
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.13
|
| Rate for Payer: Vantage Medical Group Senior |
$4.13
|
|
|
TRACE ELEMENT PEDI CR-CU-MN-ZN 1 MCG-0.1 MG-25 MCG-1 MG/ML INTRAVENOUS [18266]
|
Facility
IP
|
$4.86
|
|
|
Service Code
|
NDC 0517-9203-25
|
| Hospital Charge Code |
NDG18266
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Blue Shield of California Commercial |
$3.46
|
| Rate for Payer: Blue Shield of California EPN |
$2.49
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Networks By Design Commercial |
$3.16
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
|
|
TRACE ELEMENTS CHOLESTASIS [4080051]
|
Facility
IP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-51
|
| Hospital Charge Code |
ERX4080051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
TRACE ELEMENTS CHOLESTASIS [4080051]
|
Facility
OP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-51
|
| Hospital Charge Code |
ERX4080051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.75
|
| Rate for Payer: BCBS Transplant Transplant |
$3.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.68
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO |
$4.03
|
| Rate for Payer: Cigna of CA PPO |
$4.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Media |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
TRACE ELEMENTS FULL TERM [4080053]
|
Facility
OP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-53
|
| Hospital Charge Code |
ERX4080053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.75
|
| Rate for Payer: BCBS Transplant Transplant |
$3.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.68
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO |
$4.03
|
| Rate for Payer: Cigna of CA PPO |
$4.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Media |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
TRACE ELEMENTS FULL TERM [4080053]
|
Facility
IP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-53
|
| Hospital Charge Code |
ERX4080053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
TRACE ELEMENTS PRETERM [4080052]
|
Facility
IP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-52
|
| Hospital Charge Code |
ERX4080052
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
TRACE ELEMENTS PRETERM [4080052]
|
Facility
OP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-52
|
| Hospital Charge Code |
ERX4080052
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.75
|
| Rate for Payer: BCBS Transplant Transplant |
$3.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.68
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO |
$4.03
|
| Rate for Payer: Cigna of CA PPO |
$4.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Media |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach
|
Facility
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 57720
|
| Min. Negotiated Rate |
$577.64 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: IEHP Medi-Cal |
$6,328.01
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
IP
|
$73,798.98
|
|
|
Service Code
|
APR-DRG 0041
|
| Min. Negotiated Rate |
$56,611.59 |
| Max. Negotiated Rate |
$73,798.98 |
| Rate for Payer: IEHP Medi-Cal |
$56,611.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73,798.98
|
|
