|
LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN [233901]
|
Facility
|
IP
|
$52,020.00
|
|
|
Service Code
|
HCPCS A9607
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$10,404.00 |
| Max. Negotiated Rate |
$44,217.00 |
| Rate for Payer: Adventist Health Commercial |
$10,404.00
|
| Rate for Payer: Blue Shield of California Commercial |
$26,374.14
|
| Rate for Payer: Blue Shield of California Commercial |
$40,003.38
|
| Rate for Payer: Cash Price |
$23,409.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,414.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,808.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,808.00
|
| Rate for Payer: Galaxy Health WC |
$44,217.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31,212.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,032.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,691.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,484.80
|
| Rate for Payer: Multiplan Commercial |
$41,616.00
|
| Rate for Payer: Networks By Design Commercial |
$33,813.00
|
| Rate for Payer: Prime Health Services Commercial |
$44,217.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,523.11
|
| Rate for Payer: United Healthcare All Other HMO |
$19,002.91
|
| Rate for Payer: United Healthcare HMO Rider |
$18,591.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,036.55
|
|
|
LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN [233901]
|
Facility
|
OP
|
$52,020.00
|
|
|
Service Code
|
HCPCS A9607
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$267.32 |
| Max. Negotiated Rate |
$44,217.00 |
| Rate for Payer: Adventist Health Commercial |
$10,404.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,686.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$542.91
|
| Rate for Payer: Blue Shield of California Commercial |
$21,900.42
|
| Rate for Payer: Blue Shield of California Commercial |
$33,188.76
|
| Rate for Payer: Cash Price |
$23,409.00
|
| Rate for Payer: Cash Price |
$23,409.00
|
| Rate for Payer: Cigna of CA HMO |
$33,292.80
|
| Rate for Payer: Cigna of CA PPO |
$38,494.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$294.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,414.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.08
|
| Rate for Payer: EPIC Health Plan Senior |
$294.05
|
| Rate for Payer: Galaxy Health WC |
$44,217.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31,212.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$438.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$417.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,032.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$471.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,484.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$336.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.21
|
| Rate for Payer: Multiplan Commercial |
$41,616.00
|
| Rate for Payer: Networks By Design Commercial |
$33,813.00
|
| Rate for Payer: Prime Health Services Commercial |
$44,217.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,212.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31,212.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,523.11
|
| Rate for Payer: United Healthcare All Other HMO |
$19,002.91
|
| Rate for Payer: United Healthcare HMO Rider |
$18,591.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,036.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$334.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.05
|
| Rate for Payer: Vantage Medical Group Senior |
$294.05
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$25,704.19
|
|
|
Service Code
|
APR-DRG 6943
|
| Min. Negotiated Rate |
$20,529.53 |
| Max. Negotiated Rate |
$25,704.19 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,529.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,704.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,998.48
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$17,386.29
|
|
|
Service Code
|
APR-DRG 6942
|
| Min. Negotiated Rate |
$13,886.16 |
| Max. Negotiated Rate |
$17,386.29 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,886.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,386.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,556.16
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$54,818.19
|
|
|
Service Code
|
APR-DRG 6944
|
| Min. Negotiated Rate |
$43,782.42 |
| Max. Negotiated Rate |
$54,818.19 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43,782.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54,818.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49,047.86
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$12,698.46
|
|
|
Service Code
|
APR-DRG 6941
|
| Min. Negotiated Rate |
$10,142.06 |
| Max. Negotiated Rate |
$12,698.46 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,142.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,698.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,361.78
|
|
|
LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION [10475]
|
Facility
|
OP
|
$1,339.22
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$27,524.54 |
| Rate for Payer: Adventist Health Commercial |
$267.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,524.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,323.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,103.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,548.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$650.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5,029.87
|
| Rate for Payer: Cash Price |
$602.65
|
| Rate for Payer: Cash Price |
$602.65
|
| Rate for Payer: Cigna of CA HMO |
$937.45
|
| Rate for Payer: Cigna of CA PPO |
$937.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,103.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,103.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$937.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,155.78
|
| Rate for Payer: EPIC Health Plan Senior |
$6,103.86
|
| Rate for Payer: Galaxy Health WC |
$1,138.34
|
| Rate for Payer: Global Benefits Group Commercial |
$803.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9,100.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,548.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,548.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$850.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$486.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,768.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,991.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,435.61
|
| Rate for Payer: Multiplan Commercial |
$1,071.38
|
| Rate for Payer: Networks By Design Commercial |
$669.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$803.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$502.61
|
| Rate for Payer: United Healthcare All Other HMO |
$489.22
|
| Rate for Payer: United Healthcare HMO Rider |
$478.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$438.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,548.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,103.86
|
| Rate for Payer: Vantage Medical Group Senior |
$6,103.86
|
|
|
LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION [10475]
|
Facility
|
IP
|
$1,339.22
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$1,138.34 |
| Rate for Payer: Adventist Health Commercial |
$267.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,029.86
|
| Rate for Payer: Blue Shield of California Commercial |
$678.98
|
| Rate for Payer: Cash Price |
$602.65
|
| Rate for Payer: Cigna of CA HMO |
$937.45
|
| Rate for Payer: Cigna of CA PPO |
$937.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$937.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.69
|
| Rate for Payer: EPIC Health Plan Senior |
$535.69
|
| Rate for Payer: Galaxy Health WC |
$1,138.34
|
| Rate for Payer: Global Benefits Group Commercial |
$803.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$850.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$790.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.41
|
| Rate for Payer: Multiplan Commercial |
$1,071.38
|
| Rate for Payer: Networks By Design Commercial |
$669.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$502.61
|
| Rate for Payer: United Healthcare All Other HMO |
$489.22
|
| Rate for Payer: United Healthcare HMO Rider |
$478.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$438.59
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$118,973.17
|
|
|
Service Code
|
MSDRG 821
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$118,973.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67,865.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$118,973.17
|
| Rate for Payer: EPIC Health Plan Senior |
$79,315.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72,104.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100,946.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96,620.63
|
| 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
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$183,319.49
|
|
|
Service Code
|
MSDRG 820
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$183,319.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$177,797.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$183,319.49
|
| Rate for Payer: EPIC Health Plan Senior |
$122,212.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111,102.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155,543.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148,877.64
|
| 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
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$100,614.39
|
|
|
Service Code
|
MSDRG 822
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$100,614.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,500.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$100,614.39
|
| Rate for Payer: EPIC Health Plan Senior |
$67,076.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,978.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85,369.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81,711.08
|
| 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
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$108,198.52
|
|
|
Service Code
|
MSDRG 841
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$108,198.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,457.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$108,198.52
|
| Rate for Payer: EPIC Health Plan Senior |
$72,132.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,574.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91,804.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,870.31
|
| 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
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$136,652.34
|
|
|
Service Code
|
MSDRG 840
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$136,652.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98,069.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$136,652.34
|
| Rate for Payer: EPIC Health Plan Senior |
$91,101.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$82,819.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115,947.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110,978.26
|
| 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
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC
|
Facility
|
IP
|
$119,452.31
|
|
|
Service Code
|
MSDRG 824
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$119,452.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68,683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$119,452.31
|
| Rate for Payer: EPIC Health Plan Senior |
$79,634.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72,395.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101,353.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97,009.76
|
| 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
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC
|
Facility
|
IP
|
$160,606.10
|
|
|
Service Code
|
MSDRG 823
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$160,606.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138,992.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$160,606.10
|
| Rate for Payer: EPIC Health Plan Senior |
$107,070.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$97,337.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136,271.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130,431.62
|
| 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
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$103,194.48
|
|
|
Service Code
|
MSDRG 825
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$103,194.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,908.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$103,194.48
|
| Rate for Payer: EPIC Health Plan Senior |
$68,796.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,542.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87,558.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,806.43
|
| 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
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$97,178.98
|
|
|
Service Code
|
MSDRG 842
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$97,178.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,631.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,178.98
|
| Rate for Payer: EPIC Health Plan Senior |
$64,785.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,896.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,454.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,921.11
|
| 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
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$25,573.66
|
|
|
Service Code
|
APR-DRG 6912
|
| Min. Negotiated Rate |
$20,425.28 |
| Max. Negotiated Rate |
$25,573.66 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,425.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,573.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,881.69
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$38,590.27
|
|
|
Service Code
|
APR-DRG 6913
|
| Min. Negotiated Rate |
$30,821.44 |
| Max. Negotiated Rate |
$38,590.27 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30,821.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38,590.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,528.14
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$18,468.51
|
|
|
Service Code
|
APR-DRG 6911
|
| Min. Negotiated Rate |
$14,750.51 |
| Max. Negotiated Rate |
$18,468.51 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,750.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,468.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,524.46
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$88,431.00
|
|
|
Service Code
|
APR-DRG 6914
|
| Min. Negotiated Rate |
$70,628.44 |
| Max. Negotiated Rate |
$88,431.00 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70,628.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88,431.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79,122.47
|
|
|
LYSIS OR EXCISION OF PENILE POST-CIRCUMCISION ADHESIONS
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 54162
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$316.48 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$357.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
|
|
MACITENTAN 10 MG TABLET [203952]
|
Facility
|
OP
|
$532.71
|
|
|
Service Code
|
NDC 6621550115
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$106.54 |
| Max. Negotiated Rate |
$452.80 |
| Rate for Payer: Adventist Health Commercial |
$106.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$292.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$399.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$341.84
|
| Rate for Payer: Cash Price |
$239.72
|
| Rate for Payer: Cigna of CA HMO |
$372.90
|
| Rate for Payer: Cigna of CA PPO |
$372.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$452.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$452.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$372.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.08
|
| Rate for Payer: EPIC Health Plan Senior |
$213.08
|
| Rate for Payer: Galaxy Health WC |
$452.80
|
| Rate for Payer: Global Benefits Group Commercial |
$319.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$338.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$372.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.90
|
| Rate for Payer: Multiplan Commercial |
$426.17
|
| Rate for Payer: Networks By Design Commercial |
$346.26
|
| Rate for Payer: Prime Health Services Commercial |
$452.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$319.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.36
|
| Rate for Payer: United Healthcare All Other HMO |
$266.36
|
| Rate for Payer: United Healthcare HMO Rider |
$266.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$452.80
|
| Rate for Payer: Vantage Medical Group Senior |
$452.80
|
|
|
MACITENTAN 10 MG TABLET [203952]
|
Facility
|
IP
|
$532.71
|
|
|
Service Code
|
NDC 6621550130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$106.54 |
| Max. Negotiated Rate |
$452.80 |
| Rate for Payer: Adventist Health Commercial |
$106.54
|
| Rate for Payer: Blue Shield of California Commercial |
$270.08
|
| Rate for Payer: Blue Shield of California Commercial |
$409.65
|
| Rate for Payer: Cash Price |
$239.72
|
| Rate for Payer: Cigna of CA HMO |
$372.90
|
| Rate for Payer: Cigna of CA PPO |
$372.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$372.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.08
|
| Rate for Payer: EPIC Health Plan Senior |
$213.08
|
| Rate for Payer: Galaxy Health WC |
$452.80
|
| Rate for Payer: Global Benefits Group Commercial |
$319.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$338.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.85
|
| Rate for Payer: Multiplan Commercial |
$426.17
|
| Rate for Payer: Networks By Design Commercial |
$346.26
|
| Rate for Payer: Prime Health Services Commercial |
$452.80
|
|
|
MACITENTAN 10 MG TABLET [203952]
|
Facility
|
IP
|
$532.71
|
|
|
Service Code
|
NDC 6621550115
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$106.54 |
| Max. Negotiated Rate |
$452.80 |
| Rate for Payer: Adventist Health Commercial |
$106.54
|
| Rate for Payer: Blue Shield of California Commercial |
$270.08
|
| Rate for Payer: Blue Shield of California Commercial |
$409.65
|
| Rate for Payer: Cash Price |
$239.72
|
| Rate for Payer: Cigna of CA HMO |
$372.90
|
| Rate for Payer: Cigna of CA PPO |
$372.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$372.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.08
|
| Rate for Payer: EPIC Health Plan Senior |
$213.08
|
| Rate for Payer: Galaxy Health WC |
$452.80
|
| Rate for Payer: Global Benefits Group Commercial |
$319.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$338.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.85
|
| Rate for Payer: Multiplan Commercial |
$426.17
|
| Rate for Payer: Networks By Design Commercial |
$346.26
|
| Rate for Payer: Prime Health Services Commercial |
$452.80
|
|
