|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$13,073.94
|
|
|
Service Code
|
APR-DRG 2261
|
| Min. Negotiated Rate |
$10,029.09 |
| Max. Negotiated Rate |
$13,073.94 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,029.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,073.94
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
CPT S0170
|
| Hospital Charge Code |
1711729
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
CPT S0170
|
| Hospital Charge Code |
1711729
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$36.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.61
|
| Rate for Payer: Blue Distinction Transplant |
$0.65
|
| Rate for Payer: Blue Distinction Transplant |
$0.36
|
| Rate for Payer: Blue Distinction Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.16
|
| Rate for Payer: Dignity Health Media |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$7,420.16
|
|
|
Service Code
|
APR-DRG 1981
|
| Min. Negotiated Rate |
$5,692.05 |
| Max. Negotiated Rate |
$7,420.16 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,692.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,420.16
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$20,341.59
|
|
|
Service Code
|
APR-DRG 1984
|
| Min. Negotiated Rate |
$15,604.14 |
| Max. Negotiated Rate |
$20,341.59 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,604.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,341.59
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$11,699.52
|
|
|
Service Code
|
APR-DRG 1983
|
| Min. Negotiated Rate |
$8,974.76 |
| Max. Negotiated Rate |
$11,699.52 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,974.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,699.52
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$8,867.30
|
|
|
Service Code
|
APR-DRG 1982
|
| Min. Negotiated Rate |
$6,802.15 |
| Max. Negotiated Rate |
$8,867.30 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,802.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,867.30
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
NDG220829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,180.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,072.44
|
| Rate for Payer: Blue Distinction Transplant |
$1,080.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,326.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,051.20
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Dignity Health Media |
$1,530.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.00
|
| Rate for Payer: United Healthcare All Other HMO |
$900.00
|
| Rate for Payer: United Healthcare HMO Rider |
$900.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$900.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,530.00
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
NDG220829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Blue Shield of California Commercial |
$1,281.60
|
| Rate for Payer: Blue Shield of California EPN |
$921.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$679.68
|
| Rate for Payer: United Healthcare All Other HMO |
$663.84
|
| Rate for Payer: United Healthcare HMO Rider |
$649.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.00
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
IP
|
$229.07
|
|
|
Service Code
|
CPT J0348
|
| Hospital Charge Code |
1753552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.98 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Blue Shield of California Commercial |
$163.10
|
| Rate for Payer: Blue Shield of California EPN |
$117.28
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.98
|
| Rate for Payer: Multiplan Commercial |
$183.26
|
| Rate for Payer: Networks By Design Commercial |
$114.54
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.50
|
| Rate for Payer: United Healthcare All Other HMO |
$84.48
|
| Rate for Payer: United Healthcare HMO Rider |
$82.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.59
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
OP
|
$229.07
|
|
|
Service Code
|
CPT J0348
|
| Hospital Charge Code |
1753552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
| Rate for Payer: Blue Distinction Transplant |
$137.44
|
| Rate for Payer: Blue Shield of California Commercial |
$168.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.71
|
| Rate for Payer: Dignity Health Media |
$194.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$171.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.98
|
| Rate for Payer: Multiplan Commercial |
$183.26
|
| Rate for Payer: Networks By Design Commercial |
$114.54
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.54
|
| Rate for Payer: United Healthcare All Other HMO |
$114.54
|
| Rate for Payer: United Healthcare HMO Rider |
$114.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.71
|
| Rate for Payer: Vantage Medical Group Senior |
$194.71
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$13,382.54
|
|
|
Service Code
|
APR-DRG 0592
|
| Min. Negotiated Rate |
$10,265.81 |
| Max. Negotiated Rate |
$13,382.54 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,265.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,382.54
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$26,128.38
|
|
|
Service Code
|
APR-DRG 0594
|
| Min. Negotiated Rate |
$20,043.22 |
| Max. Negotiated Rate |
$26,128.38 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,043.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,128.38
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$8,147.28
|
|
|
Service Code
|
APR-DRG 0591
|
| Min. Negotiated Rate |
$6,249.82 |
| Max. Negotiated Rate |
$8,147.28 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,249.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,147.28
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$18,878.48
|
|
|
Service Code
|
APR-DRG 0593
|
| Min. Negotiated Rate |
$14,481.78 |
| Max. Negotiated Rate |
$18,878.48 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,481.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,878.48
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$13,394.94
|
|
|
Service Code
|
APR-DRG 5472
|
| Min. Negotiated Rate |
$10,275.33 |
| Max. Negotiated Rate |
$13,394.94 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,275.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,394.94
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$9,580.24
|
|
|
Service Code
|
APR-DRG 5471
|
| Min. Negotiated Rate |
$7,349.05 |
| Max. Negotiated Rate |
$9,580.24 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,349.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,580.24
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$19,903.54
|
|
|
Service Code
|
APR-DRG 5473
|
| Min. Negotiated Rate |
$15,268.11 |
| Max. Negotiated Rate |
$19,903.54 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,268.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,903.54
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$39,111.71
|
|
|
Service Code
|
APR-DRG 5474
|
| Min. Negotiated Rate |
$30,002.80 |
| Max. Negotiated Rate |
$39,111.71 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30,002.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39,111.71
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$17,881.09
|
|
|
Service Code
|
APR-DRG 5664
|
| Min. Negotiated Rate |
$13,716.68 |
| Max. Negotiated Rate |
$17,881.09 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,716.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,881.09
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$3,741.99
|
|
|
Service Code
|
APR-DRG 5661
|
| Min. Negotiated Rate |
$2,870.50 |
| Max. Negotiated Rate |
$3,741.99 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,870.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,741.99
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$5,034.85
|
|
|
Service Code
|
APR-DRG 5662
|
| Min. Negotiated Rate |
$3,862.26 |
| Max. Negotiated Rate |
$5,034.85 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,862.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,034.85
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$7,327.94
|
|
|
Service Code
|
APR-DRG 5663
|
| Min. Negotiated Rate |
$5,621.30 |
| Max. Negotiated Rate |
$7,327.94 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,621.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,327.94
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
|
IP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
1771241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$47.49 |
| Rate for Payer: Cash Price |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.35
|
| Rate for Payer: Galaxy Health WC |
$47.49
|
| Rate for Payer: Global Benefits Group Commercial |
$33.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.41
|
| Rate for Payer: Multiplan Commercial |
$44.70
|
| Rate for Payer: Networks By Design Commercial |
$36.32
|
| Rate for Payer: Prime Health Services Commercial |
$47.49
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
|
OP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
1771241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$47.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.29
|
| Rate for Payer: Blue Distinction Transplant |
$33.52
|
| Rate for Payer: Blue Shield of California Commercial |
$41.18
|
| Rate for Payer: Blue Shield of California EPN |
$32.63
|
| Rate for Payer: Cash Price |
$25.14
|
| Rate for Payer: Cigna of CA HMO |
$35.76
|
| Rate for Payer: Cigna of CA PPO |
$41.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.49
|
| Rate for Payer: Dignity Health Media |
$47.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.35
|
| Rate for Payer: Galaxy Health WC |
$47.49
|
| Rate for Payer: Global Benefits Group Commercial |
$33.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$41.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.41
|
| Rate for Payer: Multiplan Commercial |
$44.70
|
| Rate for Payer: Networks By Design Commercial |
$36.32
|
| Rate for Payer: Prime Health Services Commercial |
$47.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.94
|
| Rate for Payer: United Healthcare All Other HMO |
$27.94
|
| Rate for Payer: United Healthcare HMO Rider |
$27.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.49
|
| Rate for Payer: Vantage Medical Group Senior |
$47.49
|
|
