|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
IP
|
$8,384.93
|
|
|
Service Code
|
APR-DRG 0571
|
| Min. Negotiated Rate |
$6,432.12 |
| Max. Negotiated Rate |
$8,384.93 |
| Rate for Payer: IEHP Medi-Cal |
$6,432.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,384.93
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
IP
|
$30,418.39
|
|
|
Service Code
|
APR-DRG 0574
|
| Min. Negotiated Rate |
$23,334.11 |
| Max. Negotiated Rate |
$30,418.39 |
| Rate for Payer: IEHP Medi-Cal |
$23,334.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,418.39
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
IP
|
$12,497.57
|
|
|
Service Code
|
APR-DRG 0572
|
| Min. Negotiated Rate |
$9,586.95 |
| Max. Negotiated Rate |
$12,497.57 |
| Rate for Payer: IEHP Medi-Cal |
$9,586.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,497.57
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET [9973]
|
Facility
IP
|
$8.05
|
|
|
Service Code
|
NDC 0046-1100-81
|
| Hospital Charge Code |
1710526
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Blue Shield of California Commercial |
$5.73
|
| Rate for Payer: Blue Shield of California EPN |
$4.12
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cigna of CA HMO |
$5.64
|
| Rate for Payer: Cigna of CA PPO |
$5.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.84
|
| Rate for Payer: Global Benefits Group Commercial |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$6.44
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.84
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET [9973]
|
Facility
OP
|
$8.05
|
|
|
Service Code
|
NDC 0046-1100-81
|
| Hospital Charge Code |
1710526
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.80
|
| Rate for Payer: BCBS Transplant Transplant |
$4.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.70
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cigna of CA HMO |
$5.64
|
| Rate for Payer: Cigna of CA PPO |
$5.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.84
|
| Rate for Payer: Dignity Health Media |
$6.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.84
|
| Rate for Payer: Global Benefits Group Commercial |
$4.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$6.44
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.02
|
| Rate for Payer: United Healthcare All Other HMO |
$4.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.84
|
| Rate for Payer: Vantage Medical Group Senior |
$6.84
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [9977]
|
Facility
IP
|
$17.48
|
|
|
Service Code
|
NDC 0046-0872-21
|
| Hospital Charge Code |
1743781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Blue Shield of California Commercial |
$12.45
|
| Rate for Payer: Blue Shield of California EPN |
$8.95
|
| Rate for Payer: Cash Price |
$7.87
|
| Rate for Payer: Cigna of CA HMO |
$12.24
|
| Rate for Payer: Cigna of CA PPO |
$12.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$14.86
|
| Rate for Payer: Global Benefits Group Commercial |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$13.98
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.86
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [9977]
|
Facility
OP
|
$17.48
|
|
|
Service Code
|
NDC 0046-0872-21
|
| Hospital Charge Code |
1743781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Multiplan Commercial |
$13.98
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.41
|
| Rate for Payer: BCBS Transplant Transplant |
$10.49
|
| Rate for Payer: Blue Shield of California Commercial |
$12.88
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Cash Price |
$7.87
|
| Rate for Payer: Cigna of CA HMO |
$12.24
|
| Rate for Payer: Cigna of CA PPO |
$12.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.86
|
| Rate for Payer: Dignity Health Media |
$14.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$14.86
|
| Rate for Payer: Global Benefits Group Commercial |
$10.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$14.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Other HMO |
$8.74
|
| Rate for Payer: United Healthcare HMO Rider |
$8.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.86
|
| Rate for Payer: Vantage Medical Group Senior |
$14.86
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET [9974]
|
Facility
IP
|
$8.05
|
|
|
Service Code
|
NDC 0046-1102-81
|
| Hospital Charge Code |
1710519
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Blue Shield of California Commercial |
$5.73
|
| Rate for Payer: Blue Shield of California EPN |
$4.12
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cigna of CA HMO |
$5.64
|
| Rate for Payer: Cigna of CA PPO |
$5.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.84
|
| Rate for Payer: Global Benefits Group Commercial |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$6.44
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.84
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET [9974]
|
Facility
OP
|
$8.05
|
|
|
Service Code
|
NDC 0046-1102-81
|
| Hospital Charge Code |
1710519
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.80
|
| Rate for Payer: BCBS Transplant Transplant |
$4.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.70
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cigna of CA HMO |
$5.64
|
| Rate for Payer: Cigna of CA PPO |
$5.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.84
|
| Rate for Payer: Dignity Health Media |
$6.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.84
|
| Rate for Payer: Global Benefits Group Commercial |
$4.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$6.44
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.02
|
| Rate for Payer: United Healthcare All Other HMO |
$4.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.84
|
| Rate for Payer: Vantage Medical Group Senior |
$6.84
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]
|
Facility
IP
|
$428.80
|
|
|
Service Code
|
CPT J1410
|
| Hospital Charge Code |
1720160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.91 |
| Max. Negotiated Rate |
$364.48 |
| Rate for Payer: Blue Shield of California Commercial |
$305.31
|
| Rate for Payer: Blue Shield of California EPN |
$219.55
|
| Rate for Payer: Cash Price |
$192.96
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$300.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.52
|
| Rate for Payer: Galaxy Health WC |
$364.48
|
| Rate for Payer: Global Benefits Group Commercial |
$257.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.91
|
| Rate for Payer: Multiplan Commercial |
$343.04
|
| Rate for Payer: Networks By Design Commercial |
$214.40
|
| Rate for Payer: Prime Health Services Commercial |
$364.48
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]
|
Facility
OP
|
$428.80
|
|
|
Service Code
|
CPT J1410
|
| Hospital Charge Code |
1720160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.91 |
| Max. Negotiated Rate |
$2,340.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,340.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$465.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$409.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$409.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.24
|
| Rate for Payer: BCBS Transplant Transplant |
$257.28
|
| Rate for Payer: Blue Shield of California Commercial |
$316.03
|
| Rate for Payer: Blue Shield of California EPN |
$373.97
|
| Rate for Payer: Cash Price |
$192.96
|
| Rate for Payer: Cash Price |
$192.96
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$300.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$558.22
|
| Rate for Payer: Dignity Health Media |
$372.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$372.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$372.15
|
| Rate for Payer: Galaxy Health WC |
$364.48
|
| Rate for Payer: Global Benefits Group Commercial |
$257.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$321.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$610.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$610.32
|
| Rate for Payer: IEHP Medi-Cal |
$602.88
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$602.88
|
| Rate for Payer: IEHP Medicare Advantage |
$372.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$372.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$468.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.68
|
| Rate for Payer: Multiplan Commercial |
$343.04
|
| Rate for Payer: Networks By Design Commercial |
$214.40
|
| Rate for Payer: Prime Health Services Commercial |
$364.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$257.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$257.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.40
|
| Rate for Payer: United Healthcare All Other HMO |
$214.40
|
| Rate for Payer: United Healthcare HMO Rider |
$214.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$558.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.36
|
| Rate for Payer: Vantage Medical Group Senior |
$372.15
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
IP
|
$12,666.05
|
|
|
Service Code
|
APR-DRG 3462
|
| Min. Negotiated Rate |
$9,716.19 |
| Max. Negotiated Rate |
$12,666.05 |
| Rate for Payer: IEHP Medi-Cal |
$9,716.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,666.05
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
IP
|
$40,128.08
|
|
|
Service Code
|
APR-DRG 3464
|
| Min. Negotiated Rate |
$30,782.46 |
| Max. Negotiated Rate |
$40,128.08 |
| Rate for Payer: IEHP Medi-Cal |
$30,782.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40,128.08
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
IP
|
$9,511.06
|
|
|
Service Code
|
APR-DRG 3461
|
| Min. Negotiated Rate |
$7,295.98 |
| Max. Negotiated Rate |
$9,511.06 |
| Rate for Payer: IEHP Medi-Cal |
$7,295.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,511.06
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
IP
|
$19,330.71
|
|
|
Service Code
|
APR-DRG 3463
|
| Min. Negotiated Rate |
$14,828.69 |
| Max. Negotiated Rate |
$19,330.71 |
| Rate for Payer: IEHP Medi-Cal |
$14,828.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,330.71
|
|
|
Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 30901
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: IEHP Medi-Cal |
$258.55
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$258.55
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); complicated, requiring hospitalization
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 42961
|
| Min. Negotiated Rate |
$638.04 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,577.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$638.04
|
|
|
Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); simple
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 42960
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| Rate for Payer: IEHP Medi-Cal |
$1,113.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,113.65
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
IP
|
$8,679.31
|
|
|
Service Code
|
APR-DRG 3841
|
| Min. Negotiated Rate |
$6,657.95 |
| Max. Negotiated Rate |
$8,679.31 |
| Rate for Payer: IEHP Medi-Cal |
$6,657.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,679.31
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
IP
|
$10,878.41
|
|
|
Service Code
|
APR-DRG 3842
|
| Min. Negotiated Rate |
$8,344.89 |
| Max. Negotiated Rate |
$10,878.41 |
| Rate for Payer: IEHP Medi-Cal |
$8,344.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,878.41
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
IP
|
$26,569.98
|
|
|
Service Code
|
APR-DRG 3844
|
| Min. Negotiated Rate |
$20,381.97 |
| Max. Negotiated Rate |
$26,569.98 |
| Rate for Payer: IEHP Medi-Cal |
$20,381.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,569.98
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
IP
|
$15,849.42
|
|
|
Service Code
|
APR-DRG 3843
|
| Min. Negotiated Rate |
$12,158.17 |
| Max. Negotiated Rate |
$15,849.42 |
| Rate for Payer: IEHP Medi-Cal |
$12,158.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,849.42
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION [219718]
|
Facility
OP
|
$6,180.48
|
|
|
Service Code
|
CPT J9057
|
| Hospital Charge Code |
ERX219718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.56 |
| Max. Negotiated Rate |
$5,253.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$166.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$109.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$96.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.47
|
| Rate for Payer: BCBS Transplant Transplant |
$3,708.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,555.01
|
| Rate for Payer: Blue Shield of California EPN |
$93.31
|
| Rate for Payer: Cash Price |
$2,781.22
|
| Rate for Payer: Cash Price |
$2,781.22
|
| Rate for Payer: Cigna of CA HMO |
$4,326.34
|
| Rate for Payer: Cigna of CA PPO |
$4,326.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.34
|
| Rate for Payer: Dignity Health Media |
$87.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$87.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$87.56
|
| Rate for Payer: Galaxy Health WC |
$5,253.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3,708.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,635.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.60
|
| Rate for Payer: Heritage Provider Network Transplant |
$143.60
|
| Rate for Payer: IEHP Medi-Cal |
$141.85
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$141.85
|
| Rate for Payer: IEHP Medicare Advantage |
$87.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,122.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,354.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,483.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.33
|
| Rate for Payer: Multiplan Commercial |
$4,944.38
|
| Rate for Payer: Networks By Design Commercial |
$3,090.24
|
| Rate for Payer: Prime Health Services Commercial |
$5,253.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,708.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,708.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,090.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3,090.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3,090.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,090.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.32
|
| Rate for Payer: Vantage Medical Group Senior |
$87.56
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION [219718]
|
Facility
IP
|
$6,180.48
|
|
|
Service Code
|
CPT J9057
|
| Hospital Charge Code |
ERX219718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,483.32 |
| Max. Negotiated Rate |
$5,253.41 |
| Rate for Payer: Blue Shield of California Commercial |
$4,400.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,164.41
|
| Rate for Payer: Cash Price |
$2,781.22
|
| Rate for Payer: Cigna of CA HMO |
$4,326.34
|
| Rate for Payer: Cigna of CA PPO |
$4,326.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,472.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,472.19
|
| Rate for Payer: Galaxy Health WC |
$5,253.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3,708.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,122.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,354.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,483.32
|
| Rate for Payer: Multiplan Commercial |
$4,944.38
|
| Rate for Payer: Networks By Design Commercial |
$3,090.24
|
| Rate for Payer: Prime Health Services Commercial |
$5,253.41
|
|
|
COPPER CHLORIDE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080425]
|
Facility
OP
|
$2.60
|
|
|
Service Code
|
NDC 9994-0804-25
|
| Hospital Charge Code |
1715158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.55
|
| Rate for Payer: BCBS Transplant Transplant |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Media |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
