|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
|
IP
|
$39,028.38
|
|
|
Service Code
|
MSDRG 805
|
| Min. Negotiated Rate |
$5,236.00 |
| Max. Negotiated Rate |
$39,028.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,255.37
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,028.38
|
| Rate for Payer: EPIC Health Plan Senior |
$28,909.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,909.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,909.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,739.28
|
| Rate for Payer: Multiplan WC |
$18,644.09
|
| Rate for Payer: Prime Health Services WC |
$18,453.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,834.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,715.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,236.00
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$33,906.53
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$5,236.00 |
| Max. Negotiated Rate |
$33,906.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,320.39
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,906.53
|
| Rate for Payer: EPIC Health Plan Senior |
$25,115.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,115.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,115.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,655.37
|
| Rate for Payer: Multiplan WC |
$11,905.69
|
| Rate for Payer: Prime Health Services WC |
$11,784.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,834.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,715.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,236.00
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$38,605.21
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$5,236.00 |
| Max. Negotiated Rate |
$38,605.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,351.95
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,605.21
|
| Rate for Payer: EPIC Health Plan Senior |
$28,596.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,596.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,596.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,319.24
|
| Rate for Payer: Multiplan WC |
$18,087.38
|
| Rate for Payer: Prime Health Services WC |
$17,902.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,834.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,715.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,236.00
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$42,984.42
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$5,236.00 |
| Max. Negotiated Rate |
$42,984.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38,701.41
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,984.42
|
| Rate for Payer: EPIC Health Plan Senior |
$31,840.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,840.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,840.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,666.02
|
| Rate for Payer: Multiplan WC |
$23,848.74
|
| Rate for Payer: Prime Health Services WC |
$23,605.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,834.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,715.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,236.00
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$38,605.21
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$5,236.00 |
| Max. Negotiated Rate |
$38,605.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,351.95
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,605.21
|
| Rate for Payer: EPIC Health Plan Senior |
$28,596.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,596.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,596.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,319.24
|
| Rate for Payer: Multiplan WC |
$18,087.38
|
| Rate for Payer: Prime Health Services WC |
$17,902.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,834.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,715.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,236.00
|
|
|
MS-DRG 42.00: VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$81,310.54
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$81,310.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81,310.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$62,942.12
|
| Rate for Payer: EPIC Health Plan Senior |
$46,623.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46,623.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,623.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62,475.88
|
| Rate for Payer: Multiplan WC |
$50,105.53
|
| Rate for Payer: Prime Health Services WC |
$49,594.25
|
| 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
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$64,742.85
|
|
|
Service Code
|
MSDRG 032
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$64,742.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64,742.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,181.97
|
| Rate for Payer: EPIC Health Plan Senior |
$40,875.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,875.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40,875.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,773.21
|
| Rate for Payer: Multiplan WC |
$39,896.11
|
| Rate for Payer: Prime Health Services WC |
$39,489.01
|
| 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
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$127,042.23
|
|
|
Service Code
|
MSDRG 031
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$127,042.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127,042.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$84,362.38
|
| Rate for Payer: EPIC Health Plan Senior |
$62,490.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,490.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62,490.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,737.47
|
| Rate for Payer: Multiplan WC |
$78,286.50
|
| Rate for Payer: Prime Health Services WC |
$77,487.65
|
| 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
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$48,369.18
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$48,369.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,369.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$47,512.72
|
| Rate for Payer: EPIC Health Plan Senior |
$35,194.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35,194.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,194.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47,160.78
|
| Rate for Payer: Multiplan WC |
$29,806.26
|
| Rate for Payer: Prime Health Services WC |
$29,502.11
|
| 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
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$45,814.42
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$45,814.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,743.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,814.42
|
| Rate for Payer: EPIC Health Plan Senior |
$33,936.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,936.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,936.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,475.06
|
| Rate for Payer: Multiplan WC |
$27,571.96
|
| Rate for Payer: Prime Health Services WC |
$27,290.61
|
| 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
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$37,420.97
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$37,420.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,823.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,420.97
|
| Rate for Payer: EPIC Health Plan Senior |
$27,719.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,719.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,719.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,143.78
|
| Rate for Payer: Multiplan WC |
$16,529.35
|
| Rate for Payer: Prime Health Services WC |
$16,360.68
|
| 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
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$52,216.28
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$52,216.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,216.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,314.65
|
| Rate for Payer: EPIC Health Plan Senior |
$36,529.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,529.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,529.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,949.36
|
| Rate for Payer: Multiplan WC |
$32,176.94
|
| Rate for Payer: Prime Health Services WC |
$31,848.60
|
| 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
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$37,876.77
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$37,876.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,796.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,876.77
|
| Rate for Payer: EPIC Health Plan Senior |
$28,056.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,056.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,056.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,596.21
|
| Rate for Payer: Multiplan WC |
$17,129.03
|
| Rate for Payer: Prime Health Services WC |
$16,954.24
|
| 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
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$112,353.00
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$34,033.00 |
| Max. Negotiated Rate |
$112,353.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89,389.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,726.36
|
| Rate for Payer: EPIC Health Plan Senior |
$49,426.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49,426.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,426.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66,232.09
|
| Rate for Payer: Multiplan WC |
$55,084.13
|
| Rate for Payer: Prime Health Services WC |
$54,522.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$112,353.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,905.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,147.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,033.00
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$163,736.72
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$46,778.00 |
| Max. Negotiated Rate |
$163,736.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$163,736.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$101,549.74
|
| Rate for Payer: EPIC Health Plan Senior |
$75,222.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75,222.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75,222.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100,797.52
|
| Rate for Payer: Multiplan WC |
$100,898.54
|
| Rate for Payer: Prime Health Services WC |
$99,868.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$112,353.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,223.00
|
| Rate for Payer: United Healthcare HMO Rider |
$51,058.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46,778.00
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$112,353.00
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$27,650.00 |
| Max. Negotiated Rate |
$112,353.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,631.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$36,673.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,673.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,673.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49,142.46
|
| Rate for Payer: Multiplan WC |
$32,432.87
|
| Rate for Payer: Prime Health Services WC |
$32,101.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$112,353.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39,735.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30,180.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27,650.00
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$57,527.64
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$57,527.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,527.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,802.44
|
| Rate for Payer: EPIC Health Plan Senior |
$38,372.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,372.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,372.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,418.72
|
| Rate for Payer: Multiplan WC |
$35,449.92
|
| Rate for Payer: Prime Health Services WC |
$35,088.19
|
| 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
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$134,315.04
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$134,315.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$134,315.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$87,768.89
|
| Rate for Payer: EPIC Health Plan Senior |
$65,013.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,013.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65,013.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,118.75
|
| Rate for Payer: Multiplan WC |
$82,768.18
|
| Rate for Payer: Prime Health Services WC |
$81,923.61
|
| 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
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$42,167.94
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$42,167.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,958.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,167.94
|
| Rate for Payer: EPIC Health Plan Senior |
$31,235.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,235.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,235.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,855.58
|
| Rate for Payer: Multiplan WC |
$22,774.56
|
| Rate for Payer: Prime Health Services WC |
$22,542.17
|
| 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
|
|
|
MUCOSITIS COCKTAIL COMPOUND [4080306]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 9408-0306-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
MUCOSITIS COCKTAIL COMPOUND [4080306]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 9408-0306-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
MUCOSITIS COCKTAIL COMPOUND [4080306]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 9408-0306-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
MUCOSITIS COCKTAIL COMPOUND [4080306]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 9408-0306-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
MUCOSITIS COCKTAIL (PINK LADY) [4080321]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
MUCOSITIS COCKTAIL (PINK LADY) [4080321]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 9994-0803-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
