|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.88
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ANGINA PECTORIS
|
Facility
|
IP
|
$91,704.71
|
|
|
Service Code
|
MSDRG 311
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$91,704.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,278.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$91,704.71
|
| Rate for Payer: EPIC Health Plan Senior |
$61,136.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,578.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77,810.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,475.34
|
| 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
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$10,221.32
|
|
|
Service Code
|
APR-DRG 1981
|
| Min. Negotiated Rate |
$8,163.60 |
| Max. Negotiated Rate |
$10,221.32 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,163.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,221.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,145.39
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$12,399.36
|
|
|
Service Code
|
APR-DRG 1982
|
| Min. Negotiated Rate |
$9,903.17 |
| Max. Negotiated Rate |
$12,399.36 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,903.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,399.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,094.17
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$16,051.18
|
|
|
Service Code
|
APR-DRG 1983
|
| Min. Negotiated Rate |
$12,819.82 |
| Max. Negotiated Rate |
$16,051.18 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,819.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,051.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,361.58
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$36,224.70
|
|
|
Service Code
|
APR-DRG 1984
|
| Min. Negotiated Rate |
$28,932.09 |
| Max. Negotiated Rate |
$36,224.70 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28,932.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36,224.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,411.57
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
|
OP
|
$2,278.80
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$1,936.98 |
| Rate for Payer: Adventist Health Commercial |
$455.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,494.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,936.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,253.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,709.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,462.31
|
| Rate for Payer: Cash Price |
$1,025.46
|
| Rate for Payer: Cigna of CA HMO |
$1,595.16
|
| Rate for Payer: Cigna of CA PPO |
$1,595.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,936.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,936.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,936.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,595.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.52
|
| Rate for Payer: EPIC Health Plan Senior |
$911.52
|
| Rate for Payer: Galaxy Health WC |
$1,936.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,447.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$827.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,344.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,595.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,595.16
|
| Rate for Payer: Multiplan Commercial |
$1,823.04
|
| Rate for Payer: Networks By Design Commercial |
$1,139.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,936.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,367.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,367.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.23
|
| Rate for Payer: United Healthcare All Other HMO |
$832.45
|
| Rate for Payer: United Healthcare HMO Rider |
$814.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$746.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,936.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,936.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,936.98
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
|
IP
|
$2,278.80
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$1,936.98 |
| Rate for Payer: Adventist Health Commercial |
$455.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,155.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,752.40
|
| Rate for Payer: Cash Price |
$1,025.46
|
| Rate for Payer: Cigna of CA HMO |
$1,595.16
|
| Rate for Payer: Cigna of CA PPO |
$1,595.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,595.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.52
|
| Rate for Payer: EPIC Health Plan Senior |
$911.52
|
| Rate for Payer: Galaxy Health WC |
$1,936.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,447.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,344.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.91
|
| Rate for Payer: Multiplan Commercial |
$1,823.04
|
| Rate for Payer: Networks By Design Commercial |
$1,139.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,936.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.23
|
| Rate for Payer: United Healthcare All Other HMO |
$832.45
|
| Rate for Payer: United Healthcare HMO Rider |
$814.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$746.31
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
OP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.29
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$194.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Senior |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160.35
|
| Rate for Payer: Multiplan Commercial |
$183.26
|
| Rate for Payer: Networks By Design Commercial |
$114.53
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.97
|
| Rate for Payer: United Healthcare All Other HMO |
$83.68
|
| Rate for Payer: United Healthcare HMO Rider |
$81.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.71
|
| Rate for Payer: Vantage Medical Group Senior |
$194.71
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
IP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Blue Shield of California Commercial |
$116.14
|
| Rate for Payer: Blue Shield of California Commercial |
$176.15
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Senior |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.98
|
| Rate for Payer: Multiplan Commercial |
$183.26
|
| Rate for Payer: Networks By Design Commercial |
$114.53
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.97
|
| Rate for Payer: United Healthcare All Other HMO |
$83.68
|
| Rate for Payer: United Healthcare HMO Rider |
$81.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.02
|
|
|
ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOSTIC
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 45990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$140.73 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| 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 |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,997.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,498.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,783.75
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
ANORECTAL MANOMETRY
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 91122
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$55,068.46
|
|
|
Service Code
|
APR-DRG 0594
|
| Min. Negotiated Rate |
$43,982.31 |
| Max. Negotiated Rate |
$55,068.46 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43,982.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55,068.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49,271.78
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$10,838.55
|
|
|
Service Code
|
APR-DRG 0591
|
| Min. Negotiated Rate |
$8,656.58 |
| Max. Negotiated Rate |
$10,838.55 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,656.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,838.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,697.65
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$18,824.72
|
|
|
Service Code
|
APR-DRG 0592
|
| Min. Negotiated Rate |
$15,035.01 |
| Max. Negotiated Rate |
$18,824.72 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,035.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,824.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,843.17
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$27,545.06
|
|
|
Service Code
|
APR-DRG 0593
|
| Min. Negotiated Rate |
$21,999.80 |
| Max. Negotiated Rate |
$27,545.06 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21,999.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,545.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,645.58
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$70,507.83
|
|
|
Service Code
|
APR-DRG 5474
|
| Min. Negotiated Rate |
$38,907.50 |
| Max. Negotiated Rate |
$70,507.83 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38,907.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48,714.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70,507.83
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$23,557.16
|
|
|
Service Code
|
APR-DRG 5472
|
| Min. Negotiated Rate |
$12,999.27 |
| Max. Negotiated Rate |
$23,557.16 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,999.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,275.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,557.16
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$11,990.25
|
|
|
Service Code
|
APR-DRG 5471
|
| Min. Negotiated Rate |
$6,616.44 |
| Max. Negotiated Rate |
$11,990.25 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,616.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,284.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,990.25
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$36,352.31
|
|
|
Service Code
|
APR-DRG 5473
|
| Min. Negotiated Rate |
$20,059.86 |
| Max. Negotiated Rate |
$36,352.31 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,059.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,116.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,352.31
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$8,934.15
|
|
|
Service Code
|
APR-DRG 5662
|
| Min. Negotiated Rate |
$4,930.02 |
| Max. Negotiated Rate |
$8,934.15 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,930.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,172.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,934.15
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$36,449.11
|
|
|
Service Code
|
APR-DRG 5664
|
| Min. Negotiated Rate |
$20,113.28 |
| Max. Negotiated Rate |
$36,449.11 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,113.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,183.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,449.11
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$6,237.22
|
|
|
Service Code
|
APR-DRG 5661
|
| Min. Negotiated Rate |
$3,441.81 |
| Max. Negotiated Rate |
$6,237.22 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,441.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,309.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,237.22
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$16,563.14
|
|
|
Service Code
|
APR-DRG 5663
|
| Min. Negotiated Rate |
$9,139.84 |
| Max. Negotiated Rate |
$16,563.14 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,139.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,443.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,563.14
|
|
