|
COMPOUNDING VEHICLE SYRUP NO.23 [222005]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0574030416
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| 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
|
|
|
COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION INCLUDING INSERTION AND REPOSITIONING OF MULTIPLE ELECTRODE CATHETERS WITH INDUCTION OR ATTEMPTED INDUCTION OF ARRHYTHMIA; WITH LEFT ATRIAL PACING AND RECORDING FROM CORONARY SINUS OR LEFT ATRIUM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 93621
|
|
Hospital Revenue Code
|
481
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,174.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,328.75
|
| 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
|
|
|
COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION INCLUDING INSERTION AND REPOSITIONING OF MULTIPLE ELECTRODE CATHETERS WITH INDUCTION OR ATTEMPTED INDUCTION OF ARRHYTHMIA; WITH RIGHT ATRIAL PACING AND RECORDING, RIGHT VENTRICULAR PACING AND RECORDING, HIS BUNDLE RECORDING
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 93620
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,174.89 |
| 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 |
$15,047.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,034.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,031.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| 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: Dignity Health Commercial/Exchange |
$15,047.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,034.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,031.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,552.26
|
| Rate for Payer: EPIC Health Plan Senior |
$11,034.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16,451.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,174.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,031.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,044.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,639.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,442.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,031.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,047.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,034.84
|
| Rate for Payer: Vantage Medical Group Senior |
$10,031.67
|
|
|
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
|
Facility
|
IP
|
$329,659.22
|
|
|
Service Code
|
MSDRG 212
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$329,659.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$329,659.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$272,208.62
|
| Rate for Payer: EPIC Health Plan Senior |
$181,472.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$164,974.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$230,964.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221,066.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION
|
Facility
|
IP
|
$202,707.93
|
|
|
Service Code
|
MSDRG 317
|
| Min. Negotiated Rate |
$119,939.62 |
| Max. Negotiated Rate |
$202,707.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$202,707.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$197,900.37
|
| Rate for Payer: EPIC Health Plan Senior |
$131,933.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$119,939.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167,915.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160,719.09
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$11,412.29
|
|
|
Service Code
|
APR-DRG 0571
|
| Min. Negotiated Rate |
$9,114.82 |
| Max. Negotiated Rate |
$11,412.29 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,114.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,412.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,211.00
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$17,742.50
|
|
|
Service Code
|
APR-DRG 0572
|
| Min. Negotiated Rate |
$14,170.66 |
| Max. Negotiated Rate |
$17,742.50 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,170.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,742.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,874.87
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$55,308.14
|
|
|
Service Code
|
APR-DRG 0574
|
| Min. Negotiated Rate |
$44,173.74 |
| Max. Negotiated Rate |
$55,308.14 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44,173.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55,308.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49,486.24
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$25,149.48
|
|
|
Service Code
|
APR-DRG 0573
|
| Min. Negotiated Rate |
$20,086.49 |
| Max. Negotiated Rate |
$25,149.48 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,086.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,149.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,502.17
|
|
|
CONCUSSION WITH CC
|
Facility
|
IP
|
$98,744.07
|
|
|
Service Code
|
MSDRG 089
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$98,744.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,305.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$98,744.07
|
| Rate for Payer: EPIC Health Plan Senior |
$65,829.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,844.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83,782.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80,192.15
|
| 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
|
|
|
CONCUSSION WITH MCC
|
Facility
|
IP
|
$103,237.07
|
|
|
Service Code
|
MSDRG 088
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$103,237.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,981.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$103,237.07
|
| Rate for Payer: EPIC Health Plan Senior |
$68,824.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,567.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87,595.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,841.01
|
| 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
|
|
|
CONCUSSION WITHOUT CC/MCC
|
Facility
|
IP
|
$93,857.13
|
|
|
Service Code
|
MSDRG 090
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$93,857.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,956.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,857.13
|
| Rate for Payer: EPIC Health Plan Senior |
$62,571.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,883.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,636.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,223.37
|
| 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
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET [9973]
|
Facility
|
IP
|
$8.72
|
|
|
Service Code
|
NDC 0046110081
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California Commercial |
$6.71
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$6.98
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET [9973]
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
NDC 0046110081
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.60
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$6.98
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.41
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [9977]
|
Facility
|
OP
|
$18.93
|
|
|
Service Code
|
NDC 0046087221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Adventist Health Commercial |
$3.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.15
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cigna of CA HMO |
$13.25
|
| Rate for Payer: Cigna of CA PPO |
$13.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.57
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$16.09
|
| Rate for Payer: Global Benefits Group Commercial |
$11.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$15.14
|
| Rate for Payer: Networks By Design Commercial |
$12.30
|
| Rate for Payer: Prime Health Services Commercial |
$16.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9.46
|
| Rate for Payer: United Healthcare HMO Rider |
$9.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.09
|
| Rate for Payer: Vantage Medical Group Senior |
$16.09
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [9977]
|
Facility
|
IP
|
$18.93
|
|
|
Service Code
|
NDC 0046087221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Adventist Health Commercial |
$3.79
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cigna of CA HMO |
$13.25
|
| Rate for Payer: Cigna of CA PPO |
$13.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.57
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$16.09
|
| Rate for Payer: Global Benefits Group Commercial |
$11.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$15.14
|
| Rate for Payer: Networks By Design Commercial |
$12.30
|
| Rate for Payer: Prime Health Services Commercial |
$16.09
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET [9974]
|
Facility
|
IP
|
$8.72
|
|
|
Service Code
|
NDC 0046110281
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California Commercial |
$6.71
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$6.98
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET [9974]
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
NDC 0046110281
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.60
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$6.98
|
| Rate for Payer: Networks By Design Commercial |
$5.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.41
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]
|
Facility
|
IP
|
$464.47
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.89 |
| Max. Negotiated Rate |
$394.80 |
| Rate for Payer: Adventist Health Commercial |
$92.89
|
| Rate for Payer: Blue Shield of California Commercial |
$235.49
|
| Rate for Payer: Blue Shield of California Commercial |
$357.18
|
| Rate for Payer: Cash Price |
$209.01
|
| Rate for Payer: Cigna of CA HMO |
$325.13
|
| Rate for Payer: Cigna of CA PPO |
$325.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$325.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.79
|
| Rate for Payer: EPIC Health Plan Senior |
$185.79
|
| Rate for Payer: Galaxy Health WC |
$394.80
|
| Rate for Payer: Global Benefits Group Commercial |
$278.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$294.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$274.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.47
|
| Rate for Payer: Multiplan Commercial |
$371.58
|
| Rate for Payer: Networks By Design Commercial |
$232.24
|
| Rate for Payer: Prime Health Services Commercial |
$394.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.32
|
| Rate for Payer: United Healthcare All Other HMO |
$169.67
|
| Rate for Payer: United Healthcare HMO Rider |
$166.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.11
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]
|
Facility
|
OP
|
$464.47
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.89 |
| Max. Negotiated Rate |
$2,408.18 |
| Rate for Payer: Adventist Health Commercial |
$92.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,408.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$501.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$441.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$441.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.34
|
| Rate for Payer: Blue Shield of California Commercial |
$441.66
|
| Rate for Payer: Cash Price |
$209.01
|
| Rate for Payer: Cash Price |
$209.01
|
| Rate for Payer: Cigna of CA HMO |
$325.13
|
| Rate for Payer: Cigna of CA PPO |
$325.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$501.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$441.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$441.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$325.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.48
|
| Rate for Payer: EPIC Health Plan Senior |
$441.65
|
| Rate for Payer: Galaxy Health WC |
$394.80
|
| Rate for Payer: Global Benefits Group Commercial |
$278.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$658.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$401.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$401.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$294.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$752.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.01
|
| Rate for Payer: Multiplan Commercial |
$371.58
|
| Rate for Payer: Networks By Design Commercial |
$232.24
|
| Rate for Payer: Prime Health Services Commercial |
$394.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$278.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.32
|
| Rate for Payer: United Healthcare All Other HMO |
$169.67
|
| Rate for Payer: United Healthcare HMO Rider |
$166.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$401.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$501.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$441.65
|
| Rate for Payer: Vantage Medical Group Senior |
$441.65
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$29,323.38
|
|
|
Service Code
|
APR-DRG 3463
|
| Min. Negotiated Rate |
$23,420.12 |
| Max. Negotiated Rate |
$29,323.38 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,420.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,323.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,236.71
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$72,812.46
|
|
|
Service Code
|
APR-DRG 3464
|
| Min. Negotiated Rate |
$58,154.17 |
| Max. Negotiated Rate |
$72,812.46 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58,154.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72,812.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65,148.00
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$19,531.70
|
|
|
Service Code
|
APR-DRG 3462
|
| Min. Negotiated Rate |
$15,599.66 |
| Max. Negotiated Rate |
$19,531.70 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,599.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,531.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,475.73
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$14,210.31
|
|
|
Service Code
|
APR-DRG 3461
|
| Min. Negotiated Rate |
$11,349.55 |
| Max. Negotiated Rate |
$14,210.31 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,349.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,210.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,714.49
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$99,716.50
|
|
|
Service Code
|
MSDRG 546
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$99,716.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,966.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$99,716.50
|
| Rate for Payer: EPIC Health Plan Senior |
$66,477.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,434.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,607.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80,981.88
|
| 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
|
|
