|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$10,686.28
|
|
|
Service Code
|
APR-DRG 1132
|
| Min. Negotiated Rate |
$8,534.97 |
| Max. Negotiated Rate |
$10,686.28 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,534.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,686.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,561.41
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$39,906.35
|
|
|
Service Code
|
APR-DRG 7102
|
| Min. Negotiated Rate |
$31,872.57 |
| Max. Negotiated Rate |
$39,906.35 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31,872.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39,906.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,705.68
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$25,796.64
|
|
|
Service Code
|
APR-DRG 7101
|
| Min. Negotiated Rate |
$20,603.37 |
| Max. Negotiated Rate |
$25,796.64 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,603.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,796.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,081.21
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$122,695.90
|
|
|
Service Code
|
APR-DRG 7104
|
| Min. Negotiated Rate |
$97,995.28 |
| Max. Negotiated Rate |
$122,695.90 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97,995.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122,695.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109,780.54
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$59,601.19
|
|
|
Service Code
|
APR-DRG 7103
|
| Min. Negotiated Rate |
$47,602.53 |
| Max. Negotiated Rate |
$59,601.19 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47,602.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59,601.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53,327.39
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$114,705.56
|
|
|
Service Code
|
MSDRG 854
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$114,705.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60,574.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$114,705.56
|
| Rate for Payer: EPIC Health Plan Senior |
$76,470.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$69,518.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97,325.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93,154.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$166,884.20
|
|
|
Service Code
|
MSDRG 853
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$166,884.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$149,718.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$166,884.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111,256.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$101,141.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141,598.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135,530.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$105,817.17
|
|
|
Service Code
|
MSDRG 855
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$105,817.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,389.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$105,817.17
|
| Rate for Payer: EPIC Health Plan Senior |
$70,544.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64,131.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89,784.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85,936.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$105,563.44
|
|
|
Service Code
|
MSDRG 727
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$105,563.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,955.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$105,563.44
|
| Rate for Payer: EPIC Health Plan Senior |
$70,375.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,977.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89,568.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85,730.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$93,644.22
|
|
|
Service Code
|
MSDRG 728
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$93,644.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,592.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,644.22
|
| Rate for Payer: EPIC Health Plan Senior |
$62,429.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,754.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,455.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,050.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$12,206.30
|
|
|
Service Code
|
APR-DRG 2451
|
| Min. Negotiated Rate |
$9,748.98 |
| Max. Negotiated Rate |
$12,206.30 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,748.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,206.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,921.43
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$23,112.83
|
|
|
Service Code
|
APR-DRG 2453
|
| Min. Negotiated Rate |
$18,459.86 |
| Max. Negotiated Rate |
$23,112.83 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18,459.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,112.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,679.90
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$52,008.91
|
|
|
Service Code
|
APR-DRG 2454
|
| Min. Negotiated Rate |
$41,538.69 |
| Max. Negotiated Rate |
$52,008.91 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41,538.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52,008.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,534.29
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$15,893.46
|
|
|
Service Code
|
APR-DRG 2452
|
| Min. Negotiated Rate |
$12,693.86 |
| Max. Negotiated Rate |
$15,893.46 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,693.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,893.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,220.47
|
|
|
INFLAMMATORY BOWEL DISEASE WITH CC
|
Facility
|
IP
|
$96,573.89
|
|
|
Service Code
|
MSDRG 386
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$96,573.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,597.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$96,573.89
|
| Rate for Payer: EPIC Health Plan Senior |
$64,382.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,529.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,941.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,429.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
INFLAMMATORY BOWEL DISEASE WITH MCC
|
Facility
|
IP
|
$107,327.25
|
|
|
Service Code
|
MSDRG 385
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$107,327.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,969.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$107,327.25
|
| Rate for Payer: EPIC Health Plan Senior |
$71,551.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,046.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91,065.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,162.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$91,339.15
|
|
|
Service Code
|
MSDRG 387
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$91,339.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,654.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$91,339.15
|
| Rate for Payer: EPIC Health Plan Senior |
$60,892.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,357.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77,499.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,178.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
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 |
$114.00 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Blue Shield of California Commercial |
$288.99
|
| Rate for Payer: Blue Shield of California Commercial |
$438.33
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
|
|
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 |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.98
|
| 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 |
$151.85
|
| Rate for Payer: Blue Shield of California Commercial |
$57.00
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.94
|
| Rate for Payer: EPIC Health Plan Senior |
$34.63
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.18
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.48
|
| 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
|
IP
|
$904.07
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$768.46 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Blue Shield of California Commercial |
$458.36
|
| Rate for Payer: Blue Shield of California Commercial |
$695.23
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$632.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Senior |
$361.63
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$574.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$533.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.98
|
| Rate for Payer: Multiplan Commercial |
$723.26
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.30
|
| Rate for Payer: United Healthcare All Other HMO |
$330.26
|
| Rate for Payer: United Healthcare HMO Rider |
$323.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.08
|
|
|
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 |
$26.61 |
| Max. Negotiated Rate |
$768.46 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.11
|
| 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 |
$192.42
|
| Rate for Payer: Blue Shield of California Commercial |
$90.41
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$632.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.92
|
| Rate for Payer: EPIC Health Plan Senior |
$29.28
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$574.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.67
|
| Rate for Payer: Multiplan Commercial |
$723.26
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.30
|
| Rate for Payer: United Healthcare All Other HMO |
$330.26
|
| Rate for Payer: United Healthcare HMO Rider |
$323.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.62
|
| 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-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 |
$227.11 |
| Max. Negotiated Rate |
$965.21 |
| Rate for Payer: Adventist Health Commercial |
$227.11
|
| Rate for Payer: Blue Shield of California Commercial |
$575.72
|
| Rate for Payer: Blue Shield of California Commercial |
$873.23
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$794.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$794.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.22
|
| Rate for Payer: EPIC Health Plan Senior |
$454.22
|
| Rate for Payer: Galaxy Health WC |
$965.21
|
| Rate for Payer: Global Benefits Group Commercial |
$681.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$669.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.53
|
| Rate for Payer: Multiplan Commercial |
$908.43
|
| Rate for Payer: Networks By Design Commercial |
$567.77
|
| Rate for Payer: Prime Health Services Commercial |
$965.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$426.17
|
| Rate for Payer: United Healthcare All Other HMO |
$414.81
|
| Rate for Payer: United Healthcare HMO Rider |
$405.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.89
|
|
|
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 |
$965.21 |
| Rate for Payer: Adventist Health Commercial |
$227.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.98
|
| 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 |
$241.76
|
| Rate for Payer: Blue Shield of California Commercial |
$113.55
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$794.88
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$794.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.72
|
| Rate for Payer: EPIC Health Plan Senior |
$30.48
|
| Rate for Payer: Galaxy Health WC |
$965.21
|
| Rate for Payer: Global Benefits Group Commercial |
$681.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$45.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.13
|
| Rate for Payer: Multiplan Commercial |
$908.43
|
| Rate for Payer: Networks By Design Commercial |
$567.77
|
| Rate for Payer: Prime Health Services Commercial |
$965.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$681.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$681.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$426.17
|
| Rate for Payer: United Healthcare All Other HMO |
$414.81
|
| Rate for Payer: United Healthcare HMO Rider |
$405.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.71
|
| 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
|
$106,301.60
|
|
|
Service Code
|
MSDRG 351
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$106,301.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,216.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$106,301.60
|
| Rate for Payer: EPIC Health Plan Senior |
$70,867.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64,425.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90,195.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86,329.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC
|
Facility
|
IP
|
$123,467.95
|
|
|
Service Code
|
MSDRG 350
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$123,467.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75,544.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$123,467.95
|
| Rate for Payer: EPIC Health Plan Senior |
$82,311.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74,829.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104,760.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100,270.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
