|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$13,372.81
|
|
|
Service Code
|
APR-DRG 3402
|
| Min. Negotiated Rate |
$10,680.65 |
| Max. Negotiated Rate |
$13,372.81 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,680.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,372.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,965.14
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$19,091.20
|
|
|
Service Code
|
APR-DRG 3403
|
| Min. Negotiated Rate |
$15,247.84 |
| Max. Negotiated Rate |
$19,091.20 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,247.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,091.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,081.60
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$36,971.97
|
|
|
Service Code
|
APR-DRG 3404
|
| Min. Negotiated Rate |
$29,528.93 |
| Max. Negotiated Rate |
$36,971.97 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29,528.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36,971.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,080.18
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$46,848.55
|
|
|
Service Code
|
APR-DRG 3414
|
| Min. Negotiated Rate |
$37,417.19 |
| Max. Negotiated Rate |
$46,848.55 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37,417.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46,848.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,917.12
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$11,336.16
|
|
|
Service Code
|
APR-DRG 3411
|
| Min. Negotiated Rate |
$9,054.01 |
| Max. Negotiated Rate |
$11,336.16 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,054.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,336.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,142.88
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$20,613.92
|
|
|
Service Code
|
APR-DRG 3413
|
| Min. Negotiated Rate |
$16,464.01 |
| Max. Negotiated Rate |
$20,613.92 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16,464.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,613.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,444.03
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$14,077.08
|
|
|
Service Code
|
APR-DRG 3412
|
| Min. Negotiated Rate |
$11,243.14 |
| Max. Negotiated Rate |
$14,077.08 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,243.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,077.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,595.28
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$21,557.48
|
|
|
Service Code
|
APR-DRG 3423
|
| Min. Negotiated Rate |
$17,217.62 |
| Max. Negotiated Rate |
$21,557.48 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,217.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,557.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,288.27
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$14,854.75
|
|
|
Service Code
|
APR-DRG 3422
|
| Min. Negotiated Rate |
$11,864.26 |
| Max. Negotiated Rate |
$14,854.75 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,864.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,854.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,291.09
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$11,083.29
|
|
|
Service Code
|
APR-DRG 3421
|
| Min. Negotiated Rate |
$8,852.05 |
| Max. Negotiated Rate |
$11,083.29 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,852.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,083.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,916.63
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$50,133.68
|
|
|
Service Code
|
APR-DRG 3424
|
| Min. Negotiated Rate |
$40,040.98 |
| Max. Negotiated Rate |
$50,133.68 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40,040.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50,133.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44,856.46
|
|
|
FRACTURES OF FEMUR WITH MCC
|
Facility
|
IP
|
$107,068.17
|
|
|
Service Code
|
MSDRG 533
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$107,068.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,526.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$107,068.17
|
| Rate for Payer: EPIC Health Plan Senior |
$71,378.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64,889.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90,845.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86,952.33
|
| 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
|
|
|
FRACTURES OF FEMUR WITHOUT MCC
|
Facility
|
IP
|
$93,553.73
|
|
|
Service Code
|
MSDRG 534
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$93,553.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,437.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,553.73
|
| Rate for Payer: EPIC Health Plan Senior |
$62,369.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,699.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,378.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75,976.97
|
| 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
|
|
|
FRACTURES OF HIP AND PELVIS WITH MCC
|
Facility
|
IP
|
$101,998.50
|
|
|
Service Code
|
MSDRG 535
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$101,998.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38,865.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$101,998.50
|
| Rate for Payer: EPIC Health Plan Senior |
$67,999.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61,817.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86,544.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82,835.14
|
| 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
|
|
|
FRACTURES OF HIP AND PELVIS WITHOUT MCC
|
Facility
|
IP
|
$93,580.34
|
|
|
Service Code
|
MSDRG 536
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$93,580.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,483.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,580.34
|
| Rate for Payer: EPIC Health Plan Senior |
$62,386.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,715.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,401.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75,998.58
|
| 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
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC
|
Facility
|
IP
|
$104,532.43
|
|
|
Service Code
|
MSDRG 562
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$104,532.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,194.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$104,532.43
|
| Rate for Payer: EPIC Health Plan Senior |
$69,688.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,352.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,694.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,893.01
|
| 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
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC
|
Facility
|
IP
|
$95,140.09
|
|
|
Service Code
|
MSDRG 563
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$95,140.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,147.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$95,140.09
|
| Rate for Payer: EPIC Health Plan Senior |
$63,426.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,660.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80,724.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77,265.28
|
| 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
|
|
|
FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG, WITH Z-PLASTY)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 41520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.04 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$394.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$445.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,969.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
FULL TERM NEONATE WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$153,238.44
|
|
|
Service Code
|
MSDRG 793
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$153,238.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126,405.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$153,238.44
|
| Rate for Payer: EPIC Health Plan Senior |
$102,158.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92,871.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130,020.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124,448.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,809.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,601.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY
|
Facility
|
IP
|
$118,476.32
|
|
|
Service Code
|
MSDRG 934
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$118,476.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67,016.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$118,476.32
|
| Rate for Payer: EPIC Health Plan Senior |
$78,984.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$71,803.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100,525.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96,217.13
|
| 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
|
|
|
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC
|
Facility
|
IP
|
$217,447.57
|
|
|
Service Code
|
MSDRG 928
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$217,447.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$217,447.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$206,527.94
|
| Rate for Payer: EPIC Health Plan Senior |
$137,685.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125,168.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175,235.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167,725.72
|
| 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
|
|
|
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC
|
Facility
|
IP
|
$136,402.12
|
|
|
Service Code
|
MSDRG 929
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$136,402.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97,641.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$136,402.12
|
| Rate for Payer: EPIC Health Plan Senior |
$90,934.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$82,667.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115,735.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110,775.05
|
| 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
|
|
|
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS, AND/OR FEET; 20 SQ CM OR LESS
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 15240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$113.22 |
| 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 |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.47
|
| Rate for Payer: Blue Shield of California Commercial |
$19.50
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS J9394
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.92 |
| Max. Negotiated Rate |
$127.67 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.67
|
| Rate for Payer: Blue Shield of California Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.73
|
| Rate for Payer: EPIC Health Plan Senior |
$29.82
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$29.82
|
|
