|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0600053797
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0600053772
|
| 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
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0600053772
|
| 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
|
|
|
CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 59320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.61 |
| 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 |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$203.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML)SUBCUTANEOUS. [4081378]
|
Facility
|
OP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$6,425.39 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.06
|
| Rate for Payer: Blue Shield of California Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cigna of CA HMO |
$5,291.50
|
| Rate for Payer: Cigna of CA PPO |
$5,291.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,291.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$3.78
|
| Rate for Payer: Galaxy Health WC |
$6,425.39
|
| Rate for Payer: Global Benefits Group Commercial |
$4,535.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,800.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,814.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$6,047.42
|
| Rate for Payer: Networks By Design Commercial |
$3,779.64
|
| Rate for Payer: Prime Health Services Commercial |
$6,425.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,535.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,535.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,837.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,761.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,475.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3.78
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML)SUBCUTANEOUS. [4081378]
|
Facility
|
IP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,511.86 |
| Max. Negotiated Rate |
$6,425.39 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3,832.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5,813.09
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cigna of CA HMO |
$5,291.50
|
| Rate for Payer: Cigna of CA PPO |
$5,291.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,291.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,023.71
|
| Rate for Payer: EPIC Health Plan Senior |
$3,023.71
|
| Rate for Payer: Galaxy Health WC |
$6,425.39
|
| Rate for Payer: Global Benefits Group Commercial |
$4,535.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,800.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,459.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,814.23
|
| Rate for Payer: Multiplan Commercial |
$6,047.42
|
| Rate for Payer: Networks By Design Commercial |
$3,779.64
|
| Rate for Payer: Prime Health Services Commercial |
$6,425.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,837.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,761.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,475.66
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X2) SUBCUTANEOUS SYRINGE KIT [97853]
|
Facility
|
OP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$6,425.39 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.06
|
| Rate for Payer: Blue Shield of California Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cigna of CA HMO |
$5,291.50
|
| Rate for Payer: Cigna of CA PPO |
$5,291.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,291.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$3.78
|
| Rate for Payer: Galaxy Health WC |
$6,425.39
|
| Rate for Payer: Global Benefits Group Commercial |
$4,535.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,800.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,814.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$6,047.42
|
| Rate for Payer: Networks By Design Commercial |
$3,779.64
|
| Rate for Payer: Prime Health Services Commercial |
$6,425.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,535.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,535.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,837.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,761.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,475.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3.78
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X2) SUBCUTANEOUS SYRINGE KIT [97853]
|
Facility
|
IP
|
$7,559.28
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,511.86 |
| Max. Negotiated Rate |
$6,425.39 |
| Rate for Payer: Adventist Health Commercial |
$1,511.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3,832.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5,813.09
|
| Rate for Payer: Cash Price |
$3,401.68
|
| Rate for Payer: Cigna of CA HMO |
$5,291.50
|
| Rate for Payer: Cigna of CA PPO |
$5,291.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,291.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,023.71
|
| Rate for Payer: EPIC Health Plan Senior |
$3,023.71
|
| Rate for Payer: Galaxy Health WC |
$6,425.39
|
| Rate for Payer: Global Benefits Group Commercial |
$4,535.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,800.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,459.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,814.23
|
| Rate for Payer: Multiplan Commercial |
$6,047.42
|
| Rate for Payer: Networks By Design Commercial |
$3,779.64
|
| Rate for Payer: Prime Health Services Commercial |
$6,425.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,837.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,761.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,475.66
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$131,527.64
|
|
|
Service Code
|
MSDRG 472
|
| Min. Negotiated Rate |
$22,650.00 |
| Max. Negotiated Rate |
$131,527.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89,313.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$131,527.64
|
| Rate for Payer: EPIC Health Plan Senior |
$87,685.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79,713.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111,599.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106,816.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$30,096.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30,096.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24,721.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,650.00
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$164,934.07
|
|
|
Service Code
|
MSDRG 471
|
| Min. Negotiated Rate |
$24,564.00 |
| Max. Negotiated Rate |
$164,934.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146,386.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$164,934.07
|
| Rate for Payer: EPIC Health Plan Senior |
$109,956.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$99,960.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139,944.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$133,946.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,108.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42,108.00
|
| Rate for Payer: United Healthcare HMO Rider |
$34,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31,692.00
|
|
|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$122,570.05
|
|
|
Service Code
|
MSDRG 473
|
| Min. Negotiated Rate |
$22,963.00 |
| Max. Negotiated Rate |
$122,570.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$74,010.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$122,570.05
|
| Rate for Payer: EPIC Health Plan Senior |
$81,713.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74,284.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103,998.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99,541.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,292.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42,292.00
|
| Rate for Payer: United Healthcare HMO Rider |
$25,065.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,963.00
|
|
|
CESAREAN DELIVERY ONLY;
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 59514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$915.13 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,927.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$915.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,034.97
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$57,895.47
|
|
|
Service Code
|
APR-DRG 5404
|
| Min. Negotiated Rate |
$31,947.78 |
| Max. Negotiated Rate |
$57,895.47 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31,947.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,000.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57,895.47
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$18,702.06
|
|
|
Service Code
|
APR-DRG 5402
|
| Min. Negotiated Rate |
$10,320.14 |
| Max. Negotiated Rate |
$18,702.06 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,320.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,921.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,702.06
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$14,821.84
|
|
|
Service Code
|
APR-DRG 5401
|
| Min. Negotiated Rate |
$8,178.96 |
| Max. Negotiated Rate |
$14,821.84 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,178.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,240.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,821.84
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$25,737.80
|
|
|
Service Code
|
APR-DRG 5403
|
| Min. Negotiated Rate |
$14,202.59 |
| Max. Negotiated Rate |
$25,737.80 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,202.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,782.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,737.80
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$99,067.04
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$99,067.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,856.91
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$99,067.04
|
| Rate for Payer: EPIC Health Plan Senior |
$66,044.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,040.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,056.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80,454.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,817.00
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$108,519.69
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$108,519.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50,006.24
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108,519.69
|
| Rate for Payer: EPIC Health Plan Senior |
$72,346.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,769.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92,077.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88,131.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,817.00
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$96,263.36
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$96,263.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,066.98
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96,263.36
|
| Rate for Payer: EPIC Health Plan Senior |
$64,175.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,341.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,678.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,177.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,817.00
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$15,155.36
|
|
|
Service Code
|
APR-DRG 5391
|
| Min. Negotiated Rate |
$8,363.00 |
| Max. Negotiated Rate |
$15,155.36 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,363.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,470.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,155.36
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$66,927.27
|
|
|
Service Code
|
APR-DRG 5394
|
| Min. Negotiated Rate |
$36,931.69 |
| Max. Negotiated Rate |
$66,927.27 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36,931.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46,240.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66,927.27
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$32,609.97
|
|
|
Service Code
|
APR-DRG 5393
|
| Min. Negotiated Rate |
$17,994.77 |
| Max. Negotiated Rate |
$32,609.97 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,994.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,530.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,609.97
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$18,644.34
|
|
|
Service Code
|
APR-DRG 5392
|
| Min. Negotiated Rate |
$10,288.29 |
| Max. Negotiated Rate |
$18,644.34 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,288.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,881.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,644.34
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$98,060.92
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$98,060.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,137.99
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$98,060.92
|
| Rate for Payer: EPIC Health Plan Senior |
$65,373.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,430.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83,203.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,637.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,817.00
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$122,814.95
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$122,814.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$74,428.81
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$122,814.95
|
| Rate for Payer: EPIC Health Plan Senior |
$81,876.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74,433.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104,206.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99,740.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,817.00
|
|
