|
INPATIENT MS-DRG 989: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$34,949.80
|
|
|
Service Code
|
MSDRG 989
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$34,949.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,750.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,949.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,888.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,888.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,888.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,619.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,690.91
|
| Rate for Payer: Multiplan WC |
$22,639.41
|
| Rate for Payer: Prime Health Services WC |
$22,408.40
|
| 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
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$31,069.24
|
|
|
Service Code
|
APR-DRG 1762
|
| Min. Negotiated Rate |
$23,833.38 |
| Max. Negotiated Rate |
$31,069.24 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,833.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31,069.24
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$79,720.58
|
|
|
Service Code
|
APR-DRG 1764
|
| Min. Negotiated Rate |
$61,154.08 |
| Max. Negotiated Rate |
$79,720.58 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61,154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79,720.58
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$26,188.69
|
|
|
Service Code
|
APR-DRG 1761
|
| Min. Negotiated Rate |
$20,089.48 |
| Max. Negotiated Rate |
$26,188.69 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,089.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,188.69
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$48,131.71
|
|
|
Service Code
|
APR-DRG 1763
|
| Min. Negotiated Rate |
$36,922.09 |
| Max. Negotiated Rate |
$48,131.71 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36,922.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48,131.71
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
|
OP
|
$40.67
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
NDG223708
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Distinction Transplant |
$24.40
|
| Rate for Payer: Blue Shield of California Commercial |
$29.97
|
| Rate for Payer: Blue Shield of California EPN |
$23.75
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna of CA HMO |
$28.47
|
| Rate for Payer: Cigna of CA PPO |
$28.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.57
|
| Rate for Payer: Dignity Health Media |
$34.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.34
|
| Rate for Payer: United Healthcare All Other HMO |
$20.34
|
| Rate for Payer: United Healthcare HMO Rider |
$20.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.57
|
| Rate for Payer: Vantage Medical Group Senior |
$34.57
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
|
IP
|
$40.67
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
NDG223708
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Blue Shield of California Commercial |
$28.96
|
| Rate for Payer: Blue Shield of California EPN |
$20.82
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna of CA HMO |
$28.47
|
| Rate for Payer: Cigna of CA PPO |
$28.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
|
|
INSULIN GLARGINE VIAL (LANTUS) 100 UNIT/ML SUBCUTANEOUS [28282]
|
Facility
|
IP
|
$35.05
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
1721115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$29.79 |
| Rate for Payer: Blue Shield of California Commercial |
$24.96
|
| Rate for Payer: Blue Shield of California EPN |
$17.95
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cigna of CA HMO |
$24.54
|
| Rate for Payer: Cigna of CA PPO |
$24.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.02
|
| Rate for Payer: Galaxy Health WC |
$29.79
|
| Rate for Payer: Global Benefits Group Commercial |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.41
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$22.78
|
| Rate for Payer: Prime Health Services Commercial |
$29.79
|
|
|
INSULIN GLARGINE VIAL (LANTUS) 100 UNIT/ML SUBCUTANEOUS [28282]
|
Facility
|
OP
|
$35.05
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
1721115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$29.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Distinction Transplant |
$21.03
|
| Rate for Payer: Blue Shield of California Commercial |
$25.83
|
| Rate for Payer: Blue Shield of California EPN |
$20.47
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cigna of CA HMO |
$24.54
|
| Rate for Payer: Cigna of CA PPO |
$24.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.79
|
| Rate for Payer: Dignity Health Media |
$29.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.02
|
| Rate for Payer: Galaxy Health WC |
$29.79
|
| Rate for Payer: Global Benefits Group Commercial |
$21.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.41
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$22.78
|
| Rate for Payer: Prime Health Services Commercial |
$29.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.52
|
| Rate for Payer: United Healthcare All Other HMO |
$17.52
|
| Rate for Payer: United Healthcare HMO Rider |
$17.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.79
|
| Rate for Payer: Vantage Medical Group Senior |
$29.79
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
|
IP
|
$34.07
|
|
|
Service Code
|
NDC 0088-2500-33
|
| Hospital Charge Code |
1721127
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Blue Shield of California Commercial |
$24.26
|
| Rate for Payer: Blue Shield of California EPN |
$17.44
|
| Rate for Payer: Cash Price |
$15.33
|
| Rate for Payer: Cigna of CA HMO |
$23.85
|
| Rate for Payer: Cigna of CA PPO |
$23.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.63
|
| Rate for Payer: Galaxy Health WC |
$28.96
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.18
|
| Rate for Payer: Multiplan Commercial |
$27.26
|
| Rate for Payer: Networks By Design Commercial |
$22.15
|
| Rate for Payer: Prime Health Services Commercial |
$28.96
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
|
OP
|
$34.07
|
|
|
Service Code
|
NDC 0088-2500-33
|
| Hospital Charge Code |
1721127
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.30
|
| Rate for Payer: Blue Distinction Transplant |
$20.44
|
| Rate for Payer: Blue Shield of California Commercial |
$25.11
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$15.33
|
| Rate for Payer: Cigna of CA HMO |
$23.85
|
| Rate for Payer: Cigna of CA PPO |
$23.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.96
|
| Rate for Payer: Dignity Health Media |
$28.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.63
|
| Rate for Payer: Galaxy Health WC |
$28.96
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.18
|
| Rate for Payer: Multiplan Commercial |
$27.26
|
| Rate for Payer: Networks By Design Commercial |
$22.15
|
| Rate for Payer: Prime Health Services Commercial |
$28.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.04
|
| Rate for Payer: United Healthcare All Other HMO |
$17.04
|
| Rate for Payer: United Healthcare HMO Rider |
$17.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.96
|
| Rate for Payer: Vantage Medical Group Senior |
$28.96
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
|
IP
|
$26.79
|
|
|
Service Code
|
NDC 0088-2500-34
|
| Hospital Charge Code |
1721127
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California EPN |
$13.72
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Networks By Design Commercial |
$17.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
|
OP
|
$26.79
|
|
|
Service Code
|
NDC 0088-2500-34
|
| Hospital Charge Code |
1721127
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.96
|
| Rate for Payer: Blue Distinction Transplant |
$16.07
|
| Rate for Payer: Blue Shield of California Commercial |
$19.74
|
| Rate for Payer: Blue Shield of California EPN |
$15.65
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.77
|
| Rate for Payer: Dignity Health Media |
$22.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Networks By Design Commercial |
$17.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$13.40
|
| Rate for Payer: United Healthcare HMO Rider |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.77
|
| Rate for Payer: Vantage Medical Group Senior |
$22.77
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION [225937]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 0338-0126-12
|
| Hospital Charge Code |
NDG225937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| Rate for Payer: Blue Distinction Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Media |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION [225937]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 0338-0126-12
|
| Hospital Charge Code |
NDG225937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
|
INSULIN REGULAR HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN [213661]
|
Facility
|
IP
|
$114.84
|
|
|
Service Code
|
NDC 0002-8824-27
|
| Hospital Charge Code |
NDG213661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$97.61 |
| Rate for Payer: Blue Shield of California Commercial |
$81.77
|
| Rate for Payer: Blue Shield of California EPN |
$58.80
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Cigna of CA HMO |
$80.39
|
| Rate for Payer: Cigna of CA PPO |
$80.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$97.61
|
| Rate for Payer: Global Benefits Group Commercial |
$68.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.56
|
| Rate for Payer: Multiplan Commercial |
$91.87
|
| Rate for Payer: Networks By Design Commercial |
$74.65
|
| Rate for Payer: Prime Health Services Commercial |
$97.61
|
|
|
INSULIN REGULAR HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN [213661]
|
Facility
|
OP
|
$114.84
|
|
|
Service Code
|
NDC 0002-8824-01
|
| Hospital Charge Code |
NDG213661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$97.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.42
|
| Rate for Payer: Blue Distinction Transplant |
$68.90
|
| Rate for Payer: Blue Shield of California Commercial |
$84.64
|
| Rate for Payer: Blue Shield of California EPN |
$67.07
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Cigna of CA HMO |
$80.39
|
| Rate for Payer: Cigna of CA PPO |
$80.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.61
|
| Rate for Payer: Dignity Health Media |
$97.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$97.61
|
| Rate for Payer: Global Benefits Group Commercial |
$68.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$86.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.56
|
| Rate for Payer: Multiplan Commercial |
$91.87
|
| Rate for Payer: Networks By Design Commercial |
$74.65
|
| Rate for Payer: Prime Health Services Commercial |
$97.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.42
|
| Rate for Payer: United Healthcare All Other HMO |
$57.42
|
| Rate for Payer: United Healthcare HMO Rider |
$57.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.61
|
| Rate for Payer: Vantage Medical Group Senior |
$97.61
|
|
|
INSULIN REGULAR HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN [213661]
|
Facility
|
OP
|
$114.84
|
|
|
Service Code
|
NDC 0002-8824-27
|
| Hospital Charge Code |
NDG213661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$97.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.42
|
| Rate for Payer: Blue Distinction Transplant |
$68.90
|
| Rate for Payer: Blue Shield of California Commercial |
$84.64
|
| Rate for Payer: Blue Shield of California EPN |
$67.07
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Cigna of CA HMO |
$80.39
|
| Rate for Payer: Cigna of CA PPO |
$80.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.61
|
| Rate for Payer: Dignity Health Media |
$97.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$97.61
|
| Rate for Payer: Global Benefits Group Commercial |
$68.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$86.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.56
|
| Rate for Payer: Multiplan Commercial |
$91.87
|
| Rate for Payer: Networks By Design Commercial |
$74.65
|
| Rate for Payer: Prime Health Services Commercial |
$97.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.42
|
| Rate for Payer: United Healthcare All Other HMO |
$57.42
|
| Rate for Payer: United Healthcare HMO Rider |
$57.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.61
|
| Rate for Payer: Vantage Medical Group Senior |
$97.61
|
|
|
INSULIN REGULAR HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN [213661]
|
Facility
|
IP
|
$114.84
|
|
|
Service Code
|
NDC 0002-8824-01
|
| Hospital Charge Code |
NDG213661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$97.61 |
| Rate for Payer: Blue Shield of California Commercial |
$81.77
|
| Rate for Payer: Blue Shield of California EPN |
$58.80
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Cigna of CA HMO |
$80.39
|
| Rate for Payer: Cigna of CA PPO |
$80.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$97.61
|
| Rate for Payer: Global Benefits Group Commercial |
$68.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.56
|
| Rate for Payer: Multiplan Commercial |
$91.87
|
| Rate for Payer: Networks By Design Commercial |
$74.65
|
| Rate for Payer: Prime Health Services Commercial |
$97.61
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$12,391.17
|
|
|
Service Code
|
APR-DRG 8173
|
| Min. Negotiated Rate |
$9,505.33 |
| Max. Negotiated Rate |
$12,391.17 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,505.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,391.17
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$6,049.28
|
|
|
Service Code
|
APR-DRG 8171
|
| Min. Negotiated Rate |
$4,640.43 |
| Max. Negotiated Rate |
$6,049.28 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,640.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,049.28
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$22,496.34
|
|
|
Service Code
|
APR-DRG 8174
|
| Min. Negotiated Rate |
$17,257.06 |
| Max. Negotiated Rate |
$22,496.34 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,257.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,496.34
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$7,625.88
|
|
|
Service Code
|
APR-DRG 8172
|
| Min. Negotiated Rate |
$5,849.85 |
| Max. Negotiated Rate |
$7,625.88 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,849.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,625.88
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$11,495.57
|
|
|
Service Code
|
APR-DRG 1422
|
| Min. Negotiated Rate |
$8,818.31 |
| Max. Negotiated Rate |
$11,495.57 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,818.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,495.57
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$23,469.98
|
|
|
Service Code
|
APR-DRG 1424
|
| Min. Negotiated Rate |
$18,003.94 |
| Max. Negotiated Rate |
$23,469.98 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18,003.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,469.98
|
|
