|
MUCOSITIS COCKTAIL (PINK LADY) [4080321]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994080306
|
| 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 |
$0.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals 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 9994080321
|
| 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 |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| 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
|
|
|
MUCOSITIS COCKTAIL (PINK LADY) [4080321]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 9994080321
|
| 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: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
MUCOSITIS COCKTAIL (PINK LADY) [4080321]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 9994080306
|
| 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: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| 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
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$100,935.09
|
|
|
Service Code
|
APR-DRG 2992
|
| Min. Negotiated Rate |
$80,615.26 |
| Max. Negotiated Rate |
$100,935.09 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80,615.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100,935.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90,310.34
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$134,717.89
|
|
|
Service Code
|
APR-DRG 2993
|
| Min. Negotiated Rate |
$107,597.05 |
| Max. Negotiated Rate |
$134,717.89 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107,597.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134,717.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120,537.05
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$222,748.27
|
|
|
Service Code
|
APR-DRG 2994
|
| Min. Negotiated Rate |
$177,905.52 |
| Max. Negotiated Rate |
$222,748.27 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177,905.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222,748.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$199,301.08
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$85,895.43
|
|
|
Service Code
|
APR-DRG 2991
|
| Min. Negotiated Rate |
$68,603.32 |
| Max. Negotiated Rate |
$85,895.43 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68,603.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85,895.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76,853.80
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC
|
Facility
|
IP
|
$218,839.08
|
|
|
Service Code
|
MSDRG 427
|
| Min. Negotiated Rate |
$125,662.06 |
| Max. Negotiated Rate |
$218,839.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$218,839.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$207,342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$138,228.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125,662.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175,926.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168,387.16
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$334,118.70
|
|
|
Service Code
|
MSDRG 426
|
| Min. Negotiated Rate |
$166,556.90 |
| Max. Negotiated Rate |
$334,118.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$334,118.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$274,818.89
|
| Rate for Payer: EPIC Health Plan Senior |
$183,212.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$166,556.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$233,179.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$223,186.25
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC
|
Facility
|
IP
|
$179,011.01
|
|
|
Service Code
|
MSDRG 428
|
| Min. Negotiated Rate |
$108,491.52 |
| Max. Negotiated Rate |
$179,011.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$170,436.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$179,011.01
|
| Rate for Payer: EPIC Health Plan Senior |
$119,340.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$108,491.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$151,888.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$145,378.64
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$202,559.39
|
|
|
Service Code
|
MSDRG 447
|
| Min. Negotiated Rate |
$119,886.94 |
| Max. Negotiated Rate |
$202,559.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$202,559.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$197,813.45
|
| Rate for Payer: EPIC Health Plan Senior |
$131,875.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$119,886.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167,841.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160,648.50
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$154,501.89
|
|
|
Service Code
|
MSDRG 448
|
| Min. Negotiated Rate |
$93,637.51 |
| Max. Negotiated Rate |
$154,501.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128,564.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$154,501.89
|
| Rate for Payer: EPIC Health Plan Senior |
$103,001.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$93,637.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131,092.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125,474.26
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$101,269.16
|
|
|
Service Code
|
MSDRG 059
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$101,269.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,619.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$101,269.16
|
| Rate for Payer: EPIC Health Plan Senior |
$67,512.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61,375.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85,925.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82,242.84
|
| 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
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC
|
Facility
|
IP
|
$109,584.40
|
|
|
Service Code
|
MSDRG 058
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$109,584.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51,825.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$109,584.40
|
| Rate for Payer: EPIC Health Plan Senior |
$73,056.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,414.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92,980.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88,995.82
|
| 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
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC
|
Facility
|
IP
|
$95,571.32
|
|
|
Service Code
|
MSDRG 060
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$95,571.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,884.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$95,571.32
|
| Rate for Payer: EPIC Health Plan Senior |
$63,714.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,922.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,090.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77,615.49
|
| 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
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$28,050.82
|
|
|
Service Code
|
APR-DRG 0432
|
| Min. Negotiated Rate |
$22,403.75 |
| Max. Negotiated Rate |
$28,050.82 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,403.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,050.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,098.10
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$43,014.33
|
|
|
Service Code
|
APR-DRG 0433
|
| Min. Negotiated Rate |
$34,354.86 |
| Max. Negotiated Rate |
$43,014.33 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34,354.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43,014.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,486.50
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$108,677.64
|
|
|
Service Code
|
APR-DRG 0434
|
| Min. Negotiated Rate |
$86,799.12 |
| Max. Negotiated Rate |
$108,677.64 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86,799.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108,677.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$97,237.89
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$19,520.83
|
|
|
Service Code
|
APR-DRG 0431
|
| Min. Negotiated Rate |
$15,590.98 |
| Max. Negotiated Rate |
$19,520.83 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,590.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,520.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,466.00
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$78,092.66
|
|
|
Service Code
|
APR-DRG 9304
|
| Min. Negotiated Rate |
$62,371.37 |
| Max. Negotiated Rate |
$78,092.66 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62,371.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78,092.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69,872.38
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$33,179.15
|
|
|
Service Code
|
APR-DRG 9303
|
| Min. Negotiated Rate |
$26,499.66 |
| Max. Negotiated Rate |
$33,179.15 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,499.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,179.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,686.61
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$21,437.83
|
|
|
Service Code
|
APR-DRG 9302
|
| Min. Negotiated Rate |
$17,122.06 |
| Max. Negotiated Rate |
$21,437.83 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,122.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,437.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,181.22
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$16,575.98
|
|
|
Service Code
|
APR-DRG 9301
|
| Min. Negotiated Rate |
$13,238.97 |
| Max. Negotiated Rate |
$16,575.98 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,238.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,575.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,831.14
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET [120459]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 8770143233
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
