|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02UH0JZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 06U807Z
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 06BB4ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 04100JF
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 04104Z3
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 05R64JZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 041J09H
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 03R34JZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 041D49F
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 03UN37Z
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 04R907Z
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 025D0ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 041D0AF
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 06R70KZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$41,843.00
|
|
|
Service Code
|
ICD 0JH839Z
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$41,843.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,843.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02TN0ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 04104K8
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Coronary Surgery
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02FN3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
|
OP
|
$10,248.72
|
|
|
Service Code
|
CPT J0801
|
| Hospital Charge Code |
NDG9685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,459.69 |
| Max. Negotiated Rate |
$25,757.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,757.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25,757.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,119.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,119.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,504.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,504.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,106.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,866.59
|
| Rate for Payer: Blue Distinction Transplant |
$6,149.23
|
| Rate for Payer: Blue Distinction Transplant |
$4,900.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6,019.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7,553.31
|
| Rate for Payer: Blue Shield of California EPN |
$4,770.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,985.25
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cigna of CA HMO |
$5,717.71
|
| Rate for Payer: Cigna of CA HMO |
$7,174.10
|
| Rate for Payer: Cigna of CA PPO |
$5,717.71
|
| Rate for Payer: Cigna of CA PPO |
$7,174.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Dignity Health Media |
$4,095.32
|
| Rate for Payer: Dignity Health Media |
$4,095.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,504.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,504.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,528.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,528.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,095.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,095.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,095.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,095.32
|
| Rate for Payer: Galaxy Health WC |
$6,942.94
|
| Rate for Payer: Galaxy Health WC |
$8,711.41
|
| Rate for Payer: Global Benefits Group Commercial |
$4,900.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,149.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,126.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,686.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,716.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,716.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,716.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,716.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,634.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,634.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,634.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,634.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,095.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,095.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,448.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,835.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,789.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,789.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,095.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,095.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,459.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,960.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,160.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,160.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,487.73
|
| Rate for Payer: Multiplan Commercial |
$8,198.98
|
| Rate for Payer: Multiplan Commercial |
$6,534.53
|
| Rate for Payer: Networks By Design Commercial |
$4,084.08
|
| Rate for Payer: Networks By Design Commercial |
$5,124.36
|
| Rate for Payer: Prime Health Services Commercial |
$8,711.41
|
| Rate for Payer: Prime Health Services Commercial |
$6,942.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,900.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,149.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,149.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,900.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,084.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,124.36
|
| Rate for Payer: United Healthcare All Other HMO |
$5,124.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,084.08
|
| Rate for Payer: United Healthcare HMO Rider |
$5,124.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4,084.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,084.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,124.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,095.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4,095.32
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
|
IP
|
$10,248.72
|
|
|
Service Code
|
CPT J0801
|
| Hospital Charge Code |
NDG9685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,459.69 |
| Max. Negotiated Rate |
$8,711.41 |
| Rate for Payer: Blue Shield of California Commercial |
$7,297.09
|
| Rate for Payer: Blue Shield of California Commercial |
$5,815.73
|
| Rate for Payer: Blue Shield of California EPN |
$5,247.34
|
| Rate for Payer: Blue Shield of California EPN |
$4,182.10
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cigna of CA HMO |
$7,174.10
|
| Rate for Payer: Cigna of CA HMO |
$5,717.71
|
| Rate for Payer: Cigna of CA PPO |
$5,717.71
|
| Rate for Payer: Cigna of CA PPO |
$7,174.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,267.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,099.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,099.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,267.26
|
| Rate for Payer: Galaxy Health WC |
$8,711.41
|
| Rate for Payer: Galaxy Health WC |
$6,942.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4,900.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,149.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,448.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,835.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,904.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,112.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,459.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,960.36
|
| Rate for Payer: Multiplan Commercial |
$8,198.98
|
| Rate for Payer: Multiplan Commercial |
$6,534.53
|
| Rate for Payer: Networks By Design Commercial |
$5,124.36
|
| Rate for Payer: Networks By Design Commercial |
$4,084.08
|
| Rate for Payer: Prime Health Services Commercial |
$8,711.41
|
| Rate for Payer: Prime Health Services Commercial |
$6,942.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,869.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,084.30
|
| Rate for Payer: United Healthcare All Other HMO |
$3,779.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,012.42
|
| Rate for Payer: United Healthcare HMO Rider |
$3,697.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,947.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,382.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,695.49
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
|
IP
|
$96.24
|
|
|
Service Code
|
CPT J0834
|
| Hospital Charge Code |
1754264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$81.80 |
| Rate for Payer: Blue Shield of California Commercial |
$68.52
|
| Rate for Payer: Blue Shield of California EPN |
$49.27
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: Multiplan Commercial |
$76.99
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.34
|
| Rate for Payer: United Healthcare All Other HMO |
$35.49
|
| Rate for Payer: United Healthcare HMO Rider |
$34.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.76
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
|
OP
|
$96.24
|
|
|
Service Code
|
CPT J0834
|
| Hospital Charge Code |
1754264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$227.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$170.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.12
|
| Rate for Payer: Blue Distinction Transplant |
$57.74
|
| Rate for Payer: Blue Shield of California Commercial |
$70.93
|
| Rate for Payer: Blue Shield of California EPN |
$105.81
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.80
|
| Rate for Payer: Dignity Health Media |
$81.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: Multiplan Commercial |
$76.99
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.12
|
| Rate for Payer: United Healthcare All Other HMO |
$48.12
|
| Rate for Payer: United Healthcare HMO Rider |
$48.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.80
|
| Rate for Payer: Vantage Medical Group Senior |
$81.80
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [239502]
|
Facility
|
OP
|
$307.20
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
NDG239502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.73 |
| Max. Negotiated Rate |
$1,014.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,014.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.03
|
| Rate for Payer: Blue Distinction Transplant |
$184.32
|
| Rate for Payer: Blue Shield of California Commercial |
$226.41
|
| Rate for Payer: Blue Shield of California EPN |
$179.40
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$215.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.12
|
| Rate for Payer: Dignity Health Media |
$261.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.88
|
| Rate for Payer: Galaxy Health WC |
$261.12
|
| Rate for Payer: Global Benefits Group Commercial |
$184.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$230.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.73
|
| Rate for Payer: Multiplan Commercial |
$245.76
|
| Rate for Payer: Networks By Design Commercial |
$153.60
|
| Rate for Payer: Prime Health Services Commercial |
$261.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Other HMO |
$153.60
|
| Rate for Payer: United Healthcare HMO Rider |
$153.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$261.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.12
|
| Rate for Payer: Vantage Medical Group Senior |
$261.12
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [239502]
|
Facility
|
IP
|
$307.20
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
NDG239502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.73 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Blue Shield of California Commercial |
$218.73
|
| Rate for Payer: Blue Shield of California EPN |
$157.29
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$215.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.88
|
| Rate for Payer: Galaxy Health WC |
$261.12
|
| Rate for Payer: Global Benefits Group Commercial |
$184.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.73
|
| Rate for Payer: Multiplan Commercial |
$245.76
|
| Rate for Payer: Networks By Design Commercial |
$153.60
|
| Rate for Payer: Prime Health Services Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.00
|
| Rate for Payer: United Healthcare All Other HMO |
$113.30
|
| Rate for Payer: United Healthcare HMO Rider |
$110.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.38
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$61,725.28
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$47,349.79 |
| Max. Negotiated Rate |
$61,725.28 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47,349.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61,725.28
|
|
