|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$96,245.61
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$96,245.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,036.66
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96,245.61
|
| Rate for Payer: EPIC Health Plan Senior |
$64,163.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,330.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,662.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,163.10
|
| 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
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 4580297426
|
| 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: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| 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: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| 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 Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 4580297426
|
| 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
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California Commercial |
$10.33
|
| Rate for Payer: Blue Shield of California Commercial |
$15.67
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$14.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.15
|
| Rate for Payer: EPIC Health Plan Senior |
$8.15
|
| Rate for Payer: Galaxy Health WC |
$17.32
|
| Rate for Payer: Global Benefits Group Commercial |
$12.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$16.30
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: Prime Health Services Commercial |
$17.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.44
|
| Rate for Payer: United Healthcare HMO Rider |
$7.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.67
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$152.69 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.84
|
| Rate for Payer: Blue Shield of California Commercial |
$96.49
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$14.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.76
|
| Rate for Payer: EPIC Health Plan Senior |
$89.84
|
| Rate for Payer: Galaxy Health WC |
$17.32
|
| Rate for Payer: Global Benefits Group Commercial |
$12.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$133.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$81.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.44
|
| Rate for Payer: Multiplan Commercial |
$16.30
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: Prime Health Services Commercial |
$17.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.44
|
| Rate for Payer: United Healthcare HMO Rider |
$7.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$81.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Vantage Medical Group Senior |
$89.84
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California Commercial |
$10.33
|
| Rate for Payer: Blue Shield of California Commercial |
$15.67
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$14.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.15
|
| Rate for Payer: EPIC Health Plan Senior |
$8.15
|
| Rate for Payer: Galaxy Health WC |
$17.32
|
| Rate for Payer: Global Benefits Group Commercial |
$12.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$16.30
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: Prime Health Services Commercial |
$17.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.44
|
| Rate for Payer: United Healthcare HMO Rider |
$7.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.67
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$152.69 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.84
|
| Rate for Payer: Blue Shield of California Commercial |
$96.49
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$14.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.76
|
| Rate for Payer: EPIC Health Plan Senior |
$89.84
|
| Rate for Payer: Galaxy Health WC |
$17.32
|
| Rate for Payer: Global Benefits Group Commercial |
$12.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$133.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$81.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.44
|
| Rate for Payer: Multiplan Commercial |
$16.30
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: Prime Health Services Commercial |
$17.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.44
|
| Rate for Payer: United Healthcare HMO Rider |
$7.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$81.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.84
|
| Rate for Payer: Vantage Medical Group Senior |
$89.84
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (IE, PROUD FLESH)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 17250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$33.77 |
| 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 |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| 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
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$21,698.87
|
|
|
Service Code
|
APR-DRG 6952
|
| Min. Negotiated Rate |
$17,330.55 |
| Max. Negotiated Rate |
$21,698.87 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,330.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,698.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,414.78
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$42,652.68
|
|
|
Service Code
|
APR-DRG 6953
|
| Min. Negotiated Rate |
$34,066.02 |
| Max. Negotiated Rate |
$42,652.68 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34,066.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,652.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,162.93
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$14,996.15
|
|
|
Service Code
|
APR-DRG 6951
|
| Min. Negotiated Rate |
$11,977.19 |
| Max. Negotiated Rate |
$14,996.15 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,977.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,996.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,417.61
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$129,759.66
|
|
|
Service Code
|
APR-DRG 6954
|
| Min. Negotiated Rate |
$103,636.99 |
| Max. Negotiated Rate |
$129,759.66 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103,636.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$129,759.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116,100.75
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$164,501.09
|
|
|
Service Code
|
MSDRG 837
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$164,501.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$145,647.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$164,501.09
|
| Rate for Payer: EPIC Health Plan Senior |
$109,667.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$99,697.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139,576.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$133,594.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
|
IP
|
$116,290.17
|
|
|
Service Code
|
MSDRG 838
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$116,290.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63,281.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$116,290.17
|
| Rate for Payer: EPIC Health Plan Senior |
$77,526.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70,478.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$98,670.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94,441.71
|
| 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
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$104,871.36
|
|
|
Service Code
|
MSDRG 839
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$104,871.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,773.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$104,871.36
|
| Rate for Payer: EPIC Health Plan Senior |
$69,914.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,558.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,981.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85,168.26
|
| 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
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$102,463.38
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$102,463.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,659.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$102,463.38
|
| Rate for Payer: EPIC Health Plan Senior |
$68,308.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,099.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86,938.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,212.69
|
| 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
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$125,253.07
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$125,253.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78,594.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$125,253.07
|
| Rate for Payer: EPIC Health Plan Senior |
$83,502.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75,910.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106,275.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101,720.67
|
| 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
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$94,322.07
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$94,322.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,750.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$94,322.07
|
| Rate for Payer: EPIC Health Plan Senior |
$62,881.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,164.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80,030.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,600.95
|
| 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
|
|
|
CHERRY FLAVOR (BULK) ORAL SYRUP [247654]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0395266216
|
| 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
|
|
|
CHERRY FLAVOR (BULK) ORAL SYRUP [247654]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0395266216
|
| 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
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$15,433.93
|
|
|
Service Code
|
APR-DRG 2033
|
| Min. Negotiated Rate |
$12,326.83 |
| Max. Negotiated Rate |
$15,433.93 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,326.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,433.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,809.30
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$10,270.26
|
|
|
Service Code
|
APR-DRG 2031
|
| Min. Negotiated Rate |
$8,202.69 |
| Max. Negotiated Rate |
$10,270.26 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,270.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,189.18
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$12,274.27
|
|
|
Service Code
|
APR-DRG 2032
|
| Min. Negotiated Rate |
$9,803.26 |
| Max. Negotiated Rate |
$12,274.27 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,803.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,274.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,982.24
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$92,025.88
|
|
|
Service Code
|
MSDRG 313
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$92,025.88 |
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21,827.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$92,025.88
|
| Rate for Payer: EPIC Health Plan Senior |
$61,350.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,773.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78,082.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,736.17
|
| 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 Select/Navigate/Core |
$6,823.00
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$31,508.48
|
|
|
Service Code
|
APR-DRG 2034
|
| Min. Negotiated Rate |
$25,165.32 |
| Max. Negotiated Rate |
$31,508.48 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,165.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,508.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,191.80
|
|
