|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [216056]
|
Facility
|
IP
|
$1,135.54
|
|
|
Service Code
|
NDC 0069-0809-01
|
| Hospital Charge Code |
ERX216056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.53 |
| Max. Negotiated Rate |
$965.21 |
| Rate for Payer: Blue Shield of California Commercial |
$808.50
|
| Rate for Payer: Blue Shield of California EPN |
$581.40
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$794.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$454.22
|
| Rate for Payer: Galaxy Health WC |
$965.21
|
| Rate for Payer: Global Benefits Group Commercial |
$681.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$757.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.53
|
| Rate for Payer: Multiplan Commercial |
$908.43
|
| Rate for Payer: Networks By Design Commercial |
$567.77
|
| Rate for Payer: Prime Health Services Commercial |
$965.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$428.78
|
| Rate for Payer: United Healthcare All Other HMO |
$418.79
|
| Rate for Payer: United Healthcare HMO Rider |
$409.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$374.73
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [216056]
|
Facility
|
OP
|
$1,135.54
|
|
|
Service Code
|
NDC 0069-0809-01
|
| Hospital Charge Code |
ERX216056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.53 |
| Max. Negotiated Rate |
$965.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$744.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$965.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$624.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$676.55
|
| Rate for Payer: Blue Distinction Transplant |
$681.32
|
| Rate for Payer: Blue Shield of California Commercial |
$836.89
|
| Rate for Payer: Blue Shield of California EPN |
$663.16
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$794.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$965.21
|
| Rate for Payer: Dignity Health Media |
$965.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$965.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$454.22
|
| Rate for Payer: Galaxy Health WC |
$965.21
|
| Rate for Payer: Global Benefits Group Commercial |
$681.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$851.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$757.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.53
|
| Rate for Payer: Multiplan Commercial |
$908.43
|
| Rate for Payer: Networks By Design Commercial |
$567.77
|
| Rate for Payer: Prime Health Services Commercial |
$965.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$681.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$681.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$567.77
|
| Rate for Payer: United Healthcare All Other HMO |
$567.77
|
| Rate for Payer: United Healthcare HMO Rider |
$567.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$567.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$965.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$965.21
|
| Rate for Payer: Vantage Medical Group Senior |
$965.21
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$18,236.48
|
|
|
Service Code
|
APR-DRG 2282
|
| Min. Negotiated Rate |
$13,989.30 |
| Max. Negotiated Rate |
$18,236.48 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,989.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,236.48
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$42,722.66
|
|
|
Service Code
|
APR-DRG 2284
|
| Min. Negotiated Rate |
$32,772.78 |
| Max. Negotiated Rate |
$42,722.66 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32,772.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42,722.66
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$24,833.76
|
|
|
Service Code
|
APR-DRG 2283
|
| Min. Negotiated Rate |
$19,050.11 |
| Max. Negotiated Rate |
$24,833.76 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,050.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,833.76
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$14,141.57
|
|
|
Service Code
|
APR-DRG 2281
|
| Min. Negotiated Rate |
$10,848.07 |
| Max. Negotiated Rate |
$14,141.57 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,848.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,141.57
|
|
|
Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging guidance, when performed
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 64447
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$394.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 64450
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, including imaging guidance, when performed
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 64445
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 62322
|
| Min. Negotiated Rate |
$263.15 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN [219527]
|
Facility
|
IP
|
$26,288.27
|
|
|
Service Code
|
NDC 0008-0100-01
|
| Hospital Charge Code |
ERX219527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,309.18 |
| Max. Negotiated Rate |
$22,345.03 |
| Rate for Payer: Blue Shield of California Commercial |
$18,717.25
|
| Rate for Payer: Blue Shield of California EPN |
$13,459.59
|
| Rate for Payer: Cash Price |
$11,829.72
|
| Rate for Payer: Cigna of CA HMO |
$18,401.79
|
| Rate for Payer: Cigna of CA PPO |
$18,401.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,515.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,515.31
|
| Rate for Payer: Galaxy Health WC |
$22,345.03
|
| Rate for Payer: Global Benefits Group Commercial |
$15,772.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,534.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,015.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,309.18
|
| Rate for Payer: Multiplan Commercial |
$21,030.62
|
| Rate for Payer: Networks By Design Commercial |
$13,144.14
|
| Rate for Payer: Prime Health Services Commercial |
$22,345.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,926.45
|
| Rate for Payer: United Healthcare All Other HMO |
$9,695.11
|
| Rate for Payer: United Healthcare HMO Rider |
$9,484.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,675.13
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN [219527]
|
Facility
|
OP
|
$26,288.27
|
|
|
Service Code
|
NDC 0008-0100-01
|
| Hospital Charge Code |
ERX219527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,309.18 |
| Max. Negotiated Rate |
$22,345.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,242.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,345.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,458.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,458.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,662.55
|
| Rate for Payer: Blue Distinction Transplant |
$15,772.96
|
| Rate for Payer: Blue Shield of California Commercial |
$19,374.45
|
| Rate for Payer: Blue Shield of California EPN |
$15,352.35
|
| Rate for Payer: Cash Price |
$11,829.72
|
| Rate for Payer: Cigna of CA HMO |
$18,401.79
|
| Rate for Payer: Cigna of CA PPO |
$18,401.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,345.03
|
| Rate for Payer: Dignity Health Media |
$22,345.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,345.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,515.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,515.31
|
| Rate for Payer: Galaxy Health WC |
$22,345.03
|
| Rate for Payer: Global Benefits Group Commercial |
$15,772.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19,716.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,534.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,015.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,309.18
|
| Rate for Payer: Multiplan Commercial |
$21,030.62
|
| Rate for Payer: Networks By Design Commercial |
$13,144.14
|
| Rate for Payer: Prime Health Services Commercial |
$22,345.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,772.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,772.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,144.14
|
| Rate for Payer: United Healthcare All Other HMO |
$13,144.14
|
| Rate for Payer: United Healthcare HMO Rider |
$13,144.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,144.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,345.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,345.03
|
| Rate for Payer: Vantage Medical Group Senior |
$22,345.03
|
|
|
INPATIENT MS-DRG 001: HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC
|
Facility
|
IP
|
$821,521.16
|
|
|
Service Code
|
MSDRG 001
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$821,521.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$821,521.16
|
| Rate for Payer: Blue Distinction Transplant |
$242,760.00
|
| Rate for Payer: Blue Shield of California Transplant |
$140,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$424,413.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$314,380.31
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$125,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$242,950.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$314,380.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314,380.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$396,119.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$421,269.62
|
| Rate for Payer: Multiplan WC |
$578,021.72
|
| Rate for Payer: Prime Health Services WC |
$572,123.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 002: HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$371,192.14
|
|
|
Service Code
|
MSDRG 002
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$371,192.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$371,192.14
|
| Rate for Payer: Blue Distinction Transplant |
$242,760.00
|
| Rate for Payer: Blue Shield of California Transplant |
$140,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$202,058.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$149,673.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$125,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$242,950.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$149,673.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149,673.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188,588.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200,562.14
|
| Rate for Payer: Multiplan WC |
$276,690.00
|
| Rate for Payer: Prime Health Services WC |
$273,866.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 003: ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$646,346.21
|
|
|
Service Code
|
MSDRG 003
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$646,346.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$646,346.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$337,919.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250,310.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250,310.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250,310.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315,391.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335,415.91
|
| Rate for Payer: Multiplan WC |
$415,598.72
|
| Rate for Payer: Prime Health Services WC |
$411,357.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 004: TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$445,645.20
|
|
|
Service Code
|
MSDRG 004
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$445,645.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$445,645.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$238,820.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$176,904.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$176,904.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$176,904.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$222,899.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237,051.79
|
| Rate for Payer: Multiplan WC |
$282,000.73
|
| Rate for Payer: Prime Health Services WC |
$279,123.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 005: LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT
|
Facility
|
IP
|
$313,770.60
|
|
|
Service Code
|
MSDRG 005
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$313,770.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$313,770.60
|
| Rate for Payer: Blue Distinction Transplant |
$207,570.00
|
| Rate for Payer: Blue Shield of California Transplant |
$160,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$173,706.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$128,671.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$135,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$129,950.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$128,671.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128,671.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162,125.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172,419.68
|
| Rate for Payer: Multiplan WC |
$234,259.58
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services WC |
$231,869.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 006: LIVER TRANSPLANT WITHOUT MCC
|
Facility
|
IP
|
$207,570.00
|
|
|
Service Code
|
MSDRG 006
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$207,570.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146,635.46
|
| Rate for Payer: Blue Distinction Transplant |
$207,570.00
|
| Rate for Payer: Blue Shield of California Transplant |
$160,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91,181.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67,542.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$135,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$129,950.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67,542.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67,542.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85,102.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90,506.29
|
| Rate for Payer: Multiplan WC |
$98,766.08
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services WC |
$97,758.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 007: LUNG TRANSPLANT
|
Facility
|
IP
|
$371,868.18
|
|
|
Service Code
|
MSDRG 007
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$371,868.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$371,868.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$202,392.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$149,920.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$149,920.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149,920.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188,899.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200,893.47
|
| Rate for Payer: Multiplan WC |
$250,694.93
|
| Rate for Payer: Prime Health Services WC |
$248,136.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 008: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
|
IP
|
$159,513.70
|
|
|
Service Code
|
MSDRG 008
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$159,513.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$159,513.70
|
| Rate for Payer: Blue Distinction Transplant |
$135,605.00
|
| Rate for Payer: Blue Shield of California Transplant |
$102,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,540.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$72,252.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$90,300.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$96,050.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72,252.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72,252.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91,037.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96,817.95
|
| Rate for Payer: Multiplan WC |
$114,821.49
|
| Rate for Payer: Networks By Design Commercial |
$85,000.00
|
| Rate for Payer: Prime Health Services WC |
$113,649.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 010: PANCREAS TRANSPLANT
|
Facility
|
IP
|
$145,929.10
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$145,929.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$145,929.10
|
| Rate for Payer: Blue Distinction Transplant |
$112,995.00
|
| Rate for Payer: Blue Shield of California Transplant |
$95,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$90,832.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67,283.67
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$70,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$77,857.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67,283.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67,283.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84,777.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90,160.12
|
| Rate for Payer: Multiplan WC |
$85,160.66
|
| Rate for Payer: Networks By Design Commercial |
$60,000.00
|
| Rate for Payer: Prime Health Services WC |
$84,291.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 011: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC
|
Facility
|
IP
|
$156,318.39
|
|
|
Service Code
|
MSDRG 011
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$156,318.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$156,318.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$95,962.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$71,083.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$71,083.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71,083.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89,565.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95,251.93
|
| Rate for Payer: Multiplan WC |
$106,075.00
|
| Rate for Payer: Prime Health Services WC |
$104,992.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 012: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC
|
Facility
|
IP
|
$121,412.55
|
|
|
Service Code
|
MSDRG 012
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$121,412.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$121,412.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$78,727.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$58,316.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,316.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58,316.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73,479.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,144.49
|
| Rate for Payer: Multiplan WC |
$80,287.35
|
| Rate for Payer: Prime Health Services WC |
$79,468.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 013: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$81,419.68
|
|
|
Service Code
|
MSDRG 013
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$81,419.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81,419.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,980.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$43,689.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43,689.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43,689.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55,048.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58,543.88
|
| Rate for Payer: Multiplan WC |
$58,083.32
|
| Rate for Payer: Prime Health Services WC |
$57,490.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 014: ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$347,448.64
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$347,448.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$347,448.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$190,335.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$140,989.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$165,000.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140,989.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140,989.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177,646.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188,925.38
|
| Rate for Payer: Multiplan WC |
$229,864.78
|
| Rate for Payer: Prime Health Services WC |
$227,519.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
