|
NITROGLYCERIN 40 MCG/ML BOLUS FOR ANESTHESIA [4080670]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
|
|
NITROGLYCERIN 40 MCG/ML BOLUS FOR ANESTHESIA [4080670]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]
|
Facility
|
IP
|
$2.03
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.42
|
| Rate for Payer: Cigna of CA PPO |
$1.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Senior |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]
|
Facility
|
OP
|
$2.03
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.42
|
| Rate for Payer: Cigna of CA PPO |
$1.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Senior |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1.73
|
|
|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
|
|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
OP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$344.33 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.26
|
| Rate for Payer: Blue Shield of California Commercial |
$38.17
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO |
$283.57
|
| Rate for Payer: Cigna of CA PPO |
$283.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.46
|
| Rate for Payer: EPIC Health Plan Senior |
$37.64
|
| Rate for Payer: Galaxy Health WC |
$344.33
|
| Rate for Payer: Global Benefits Group Commercial |
$243.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$56.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.85
|
| Rate for Payer: Multiplan Commercial |
$324.08
|
| Rate for Payer: Networks By Design Commercial |
$202.55
|
| Rate for Payer: Prime Health Services Commercial |
$344.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.03
|
| Rate for Payer: United Healthcare All Other HMO |
$147.98
|
| Rate for Payer: United Healthcare HMO Rider |
$144.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$34.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Vantage Medical Group Senior |
$37.64
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
IP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$344.33 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Blue Shield of California Commercial |
$205.39
|
| Rate for Payer: Blue Shield of California Commercial |
$311.52
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO |
$283.57
|
| Rate for Payer: Cigna of CA PPO |
$283.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.04
|
| Rate for Payer: EPIC Health Plan Senior |
$162.04
|
| Rate for Payer: Galaxy Health WC |
$344.33
|
| Rate for Payer: Global Benefits Group Commercial |
$243.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.22
|
| Rate for Payer: Multiplan Commercial |
$324.08
|
| Rate for Payer: Networks By Design Commercial |
$202.55
|
| Rate for Payer: Prime Health Services Commercial |
$344.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.03
|
| Rate for Payer: United Healthcare All Other HMO |
$147.98
|
| Rate for Payer: United Healthcare HMO Rider |
$144.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.67
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
OP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$344.33 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.26
|
| Rate for Payer: Blue Shield of California Commercial |
$38.17
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO |
$283.57
|
| Rate for Payer: Cigna of CA PPO |
$283.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.46
|
| Rate for Payer: EPIC Health Plan Senior |
$37.64
|
| Rate for Payer: Galaxy Health WC |
$344.33
|
| Rate for Payer: Global Benefits Group Commercial |
$243.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$56.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.85
|
| Rate for Payer: Multiplan Commercial |
$324.08
|
| Rate for Payer: Networks By Design Commercial |
$202.55
|
| Rate for Payer: Prime Health Services Commercial |
$344.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.03
|
| Rate for Payer: United Healthcare All Other HMO |
$147.98
|
| Rate for Payer: United Healthcare HMO Rider |
$144.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$34.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Vantage Medical Group Senior |
$37.64
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
IP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$344.33 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Blue Shield of California Commercial |
$205.39
|
| Rate for Payer: Blue Shield of California Commercial |
$311.52
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO |
$283.57
|
| Rate for Payer: Cigna of CA PPO |
$283.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.04
|
| Rate for Payer: EPIC Health Plan Senior |
$162.04
|
| Rate for Payer: Galaxy Health WC |
$344.33
|
| Rate for Payer: Global Benefits Group Commercial |
$243.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.22
|
| Rate for Payer: Multiplan Commercial |
$324.08
|
| Rate for Payer: Networks By Design Commercial |
$202.55
|
| Rate for Payer: Prime Health Services Commercial |
$344.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.03
|
| Rate for Payer: United Healthcare All Other HMO |
$147.98
|
| Rate for Payer: United Healthcare HMO Rider |
$144.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.67
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
IP
|
$943.82
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.76 |
| Max. Negotiated Rate |
$802.25 |
| Rate for Payer: Adventist Health Commercial |
$188.76
|
| Rate for Payer: Blue Shield of California Commercial |
$478.52
|
| Rate for Payer: Blue Shield of California Commercial |
$725.80
|
| Rate for Payer: Cash Price |
$424.72
|
| Rate for Payer: Cigna of CA HMO |
$660.67
|
| Rate for Payer: Cigna of CA PPO |
$660.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.53
|
| Rate for Payer: EPIC Health Plan Senior |
$377.53
|
| Rate for Payer: Galaxy Health WC |
$802.25
|
| Rate for Payer: Global Benefits Group Commercial |
$566.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$599.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$556.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.52
|
| Rate for Payer: Multiplan Commercial |
$755.06
|
| Rate for Payer: Networks By Design Commercial |
$471.91
|
| Rate for Payer: Prime Health Services Commercial |
$802.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.22
|
| Rate for Payer: United Healthcare All Other HMO |
$344.78
|
| Rate for Payer: United Healthcare HMO Rider |
$337.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.10
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
OP
|
$943.82
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.76 |
| Max. Negotiated Rate |
$1,220.66 |
| Rate for Payer: Adventist Health Commercial |
$188.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,220.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.33
|
| Rate for Payer: Blue Shield of California Commercial |
$222.35
|
| Rate for Payer: Cash Price |
$424.72
|
| Rate for Payer: Cash Price |
$424.72
|
| Rate for Payer: Cigna of CA HMO |
$660.67
|
| Rate for Payer: Cigna of CA PPO |
$660.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.09
|
| Rate for Payer: EPIC Health Plan Senior |
$226.06
|
| Rate for Payer: Galaxy Health WC |
$802.25
|
| Rate for Payer: Global Benefits Group Commercial |
$566.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$337.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$205.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$599.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$383.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$258.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$275.38
|
| Rate for Payer: Multiplan Commercial |
$755.06
|
| Rate for Payer: Networks By Design Commercial |
$471.91
|
| Rate for Payer: Prime Health Services Commercial |
$802.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.22
|
| Rate for Payer: United Healthcare All Other HMO |
$344.78
|
| Rate for Payer: United Healthcare HMO Rider |
$337.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$205.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.06
|
| Rate for Payer: Vantage Medical Group Senior |
$226.06
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
IP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$344.33 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Blue Shield of California Commercial |
$205.39
|
| Rate for Payer: Blue Shield of California Commercial |
$311.52
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO |
$283.57
|
| Rate for Payer: Cigna of CA PPO |
$283.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.04
|
| Rate for Payer: EPIC Health Plan Senior |
$162.04
|
| Rate for Payer: Galaxy Health WC |
$344.33
|
| Rate for Payer: Global Benefits Group Commercial |
$243.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.22
|
| Rate for Payer: Multiplan Commercial |
$324.08
|
| Rate for Payer: Networks By Design Commercial |
$202.55
|
| Rate for Payer: Prime Health Services Commercial |
$344.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.03
|
| Rate for Payer: United Healthcare All Other HMO |
$147.98
|
| Rate for Payer: United Healthcare HMO Rider |
$144.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.67
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
OP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$344.33 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.26
|
| Rate for Payer: Blue Shield of California Commercial |
$38.17
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cigna of CA HMO |
$283.57
|
| Rate for Payer: Cigna of CA PPO |
$283.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.46
|
| Rate for Payer: EPIC Health Plan Senior |
$37.64
|
| Rate for Payer: Galaxy Health WC |
$344.33
|
| Rate for Payer: Global Benefits Group Commercial |
$243.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$56.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.85
|
| Rate for Payer: Multiplan Commercial |
$324.08
|
| Rate for Payer: Networks By Design Commercial |
$202.55
|
| Rate for Payer: Prime Health Services Commercial |
$344.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.03
|
| Rate for Payer: United Healthcare All Other HMO |
$147.98
|
| Rate for Payer: United Healthcare HMO Rider |
$144.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$34.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Vantage Medical Group Senior |
$37.64
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
IP
|
$540.38
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$459.32 |
| Rate for Payer: Adventist Health Commercial |
$108.08
|
| Rate for Payer: Blue Shield of California Commercial |
$273.97
|
| Rate for Payer: Blue Shield of California Commercial |
$415.55
|
| Rate for Payer: Cash Price |
$243.17
|
| Rate for Payer: Cigna of CA HMO |
$378.27
|
| Rate for Payer: Cigna of CA PPO |
$378.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.15
|
| Rate for Payer: EPIC Health Plan Senior |
$216.15
|
| Rate for Payer: Galaxy Health WC |
$459.32
|
| Rate for Payer: Global Benefits Group Commercial |
$324.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$343.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.69
|
| Rate for Payer: Multiplan Commercial |
$432.30
|
| Rate for Payer: Networks By Design Commercial |
$270.19
|
| Rate for Payer: Prime Health Services Commercial |
$459.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.80
|
| Rate for Payer: United Healthcare All Other HMO |
$197.40
|
| Rate for Payer: United Healthcare HMO Rider |
$193.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.97
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
OP
|
$540.38
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$2,109.26 |
| Rate for Payer: Adventist Health Commercial |
$108.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,469.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,109.26
|
| Rate for Payer: Blue Shield of California Commercial |
$228.16
|
| Rate for Payer: Cash Price |
$243.17
|
| Rate for Payer: Cash Price |
$243.17
|
| Rate for Payer: Cigna of CA HMO |
$378.27
|
| Rate for Payer: Cigna of CA PPO |
$378.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.15
|
| Rate for Payer: EPIC Health Plan Senior |
$216.15
|
| Rate for Payer: Galaxy Health WC |
$459.32
|
| Rate for Payer: Global Benefits Group Commercial |
$324.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$385.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$343.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$436.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.27
|
| Rate for Payer: Multiplan Commercial |
$432.30
|
| Rate for Payer: Networks By Design Commercial |
$270.19
|
| Rate for Payer: Prime Health Services Commercial |
$459.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.80
|
| Rate for Payer: United Healthcare All Other HMO |
$197.40
|
| Rate for Payer: United Healthcare HMO Rider |
$193.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.32
|
| Rate for Payer: Vantage Medical Group Senior |
$459.32
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
|
IP
|
$119,972.21
|
|
|
Service Code
|
MSDRG 098
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$119,972.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69,572.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$119,972.21
|
| Rate for Payer: EPIC Health Plan Senior |
$79,981.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72,710.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101,794.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97,431.98
|
| 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
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
|
IP
|
$143,340.38
|
|
|
Service Code
|
MSDRG 097
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$143,340.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109,495.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$143,340.38
|
| Rate for Payer: EPIC Health Plan Senior |
$95,560.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$86,872.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$121,622.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116,409.77
|
| 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
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$103,425.18
|
|
|
Service Code
|
MSDRG 099
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$103,425.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,302.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$103,425.18
|
| Rate for Payer: EPIC Health Plan Senior |
$68,950.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,681.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87,754.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,993.79
|
| 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
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$26,106.63
|
|
|
Service Code
|
APR-DRG 0502
|
| Min. Negotiated Rate |
$20,850.95 |
| Max. Negotiated Rate |
$26,106.63 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,850.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,106.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,358.56
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$15,499.19
|
|
|
Service Code
|
APR-DRG 0501
|
| Min. Negotiated Rate |
$12,378.96 |
| Max. Negotiated Rate |
$15,499.19 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,378.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,499.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,867.70
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$40,942.34
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$32,700.00 |
| Max. Negotiated Rate |
$40,942.34 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32,700.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,942.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,632.62
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$94,370.34
|
|
|
Service Code
|
APR-DRG 0504
|
| Min. Negotiated Rate |
$75,372.10 |
| Max. Negotiated Rate |
$94,370.34 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75,372.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94,370.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84,436.62
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$36,553.62
|
|
|
Service Code
|
APR-DRG 3231
|
| Min. Negotiated Rate |
$29,194.80 |
| Max. Negotiated Rate |
$36,553.62 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29,194.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36,553.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,705.88
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$42,035.45
|
|
|
Service Code
|
APR-DRG 3232
|
| Min. Negotiated Rate |
$33,573.05 |
| Max. Negotiated Rate |
$42,035.45 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33,573.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,035.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,610.66
|
|
