|
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: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$1,844.90
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,844.90
|
| Rate for Payer: 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$22,345.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,458.55
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant 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
|
MS-DRG 001
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$821,521.16 |
| Rate for Payer: BCBS Transplant 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 Transplant Other |
$125,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$242,950.00
|
| Rate for Payer: 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
|
MS-DRG 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: BCBS Transplant 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 Transplant Other |
$125,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$242,950.00
|
| Rate for Payer: 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
|
MS-DRG 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: 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
|
MS-DRG 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: 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
|
MS-DRG 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: BCBS Transplant 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 Transplant Other |
$135,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$129,950.00
|
| Rate for Payer: 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
|
MS-DRG 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: BCBS Transplant 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 Transplant Other |
$135,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$129,950.00
|
| Rate for Payer: 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
|
MS-DRG 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: 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
|
MS-DRG 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: BCBS Transplant 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 Transplant Other |
$90,300.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$96,050.00
|
| Rate for Payer: 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
|
MS-DRG 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: BCBS Transplant 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 Transplant Other |
$70,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$77,857.00
|
| Rate for Payer: 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
|
MS-DRG 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: 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
|
MS-DRG 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: 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
|
MS-DRG 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: 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
|
MS-DRG 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 Transplant Other |
$165,000.00
|
| Rate for Payer: 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
|
|
|
INPATIENT MS-DRG 016: AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
IP
|
$187,261.93
|
|
|
Service Code
|
MS-DRG 016
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$187,261.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$187,261.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$111,241.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$82,401.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90,244.00
|
| Rate for Payer: IEHP Medicare Advantage |
$82,401.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82,401.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$103,825.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110,417.43
|
| Rate for Payer: Multiplan WC |
$124,952.14
|
| Rate for Payer: Networks By Design Commercial |
$140,000.00
|
| Rate for Payer: Prime Health Services WC |
$123,677.11
|
| 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
|
|
|
INPATIENT MS-DRG 017: AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
IP
|
$187,261.93
|
|
|
Service Code
|
MS-DRG 017
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$187,261.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$187,261.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$111,241.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$82,401.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90,244.00
|
| Rate for Payer: IEHP Medicare Advantage |
$82,401.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82,401.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$103,825.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110,417.43
|
| Rate for Payer: Multiplan WC |
$89,746.46
|
| Rate for Payer: Networks By Design Commercial |
$140,000.00
|
| Rate for Payer: Prime Health Services WC |
$88,830.68
|
| 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
|
|
|
INPATIENT MS-DRG 018: CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
IP
|
$1,116,923.29
|
|
|
Service Code
|
MS-DRG 018
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$1,116,923.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,116,923.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$570,271.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$422,423.14
|
| Rate for Payer: IEHP Medicare Advantage |
$422,423.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422,423.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$532,253.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$566,047.01
|
| Rate for Payer: Multiplan WC |
$742,295.04
|
| Rate for Payer: Prime Health Services WC |
$734,720.60
|
| 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
|
|
|
INPATIENT MS-DRG 019: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS
|
Facility
IP
|
$242,330.95
|
|
|
Service Code
|
MS-DRG 019
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$242,330.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242,330.95
|
| Rate for Payer: BCBS Transplant Transplant |
$135,605.00
|
| Rate for Payer: Blue Shield of California Transplant |
$102,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$138,432.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$102,542.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90,300.00
|
| Rate for Payer: IEHP Medicare Advantage |
$102,542.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102,542.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$129,203.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137,406.91
|
| Rate for Payer: Multiplan WC |
$146,519.55
|
| Rate for Payer: Prime Health Services WC |
$145,024.45
|
| 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 020: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC
|
Facility
IP
|
$256,242.96
|
|
|
Service Code
|
MS-DRG 020
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$256,242.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$256,242.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$145,301.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$107,630.77
|
| Rate for Payer: IEHP Medicare Advantage |
$107,630.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107,630.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135,614.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$144,225.23
|
| Rate for Payer: Multiplan WC |
$191,057.00
|
| Rate for Payer: Prime Health Services WC |
$189,107.44
|
| 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 021: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC
|
Facility
IP
|
$186,182.68
|
|
|
Service Code
|
MS-DRG 021
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$186,182.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$186,182.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$110,708.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$82,006.34
|
| Rate for Payer: IEHP Medicare Advantage |
$82,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82,006.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$103,327.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109,888.50
|
| Rate for Payer: Multiplan WC |
$139,426.25
|
| Rate for Payer: Prime Health Services WC |
$138,003.53
|
| 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 022: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC
|
Facility
IP
|
$105,399.64
|
|
|
Service Code
|
MS-DRG 022
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$105,399.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105,399.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$77,497.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$57,405.34
|
| Rate for Payer: IEHP Medicare Advantage |
$57,405.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57,405.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72,330.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,923.16
|
| Rate for Payer: Multiplan WC |
$89,508.23
|
| Rate for Payer: Prime Health Services WC |
$88,594.88
|
| 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 023: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
IP
|
$171,855.34
|
|
|
Service Code
|
MS-DRG 023
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$171,855.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$171,855.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$103,634.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76,766.14
|
| Rate for Payer: IEHP Medicare Advantage |
$76,766.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76,766.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96,725.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102,866.63
|
| Rate for Payer: Multiplan WC |
$117,702.76
|
| Rate for Payer: Prime Health Services WC |
$116,501.71
|
| 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 024: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
IP
|
$114,861.26
|
|
|
Service Code
|
MS-DRG 024
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$114,861.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114,861.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$75,492.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$55,920.65
|
| Rate for Payer: IEHP Medicare Advantage |
$55,920.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55,920.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70,460.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,933.67
|
| Rate for Payer: Multiplan WC |
$81,094.44
|
| Rate for Payer: Prime Health Services WC |
$80,266.95
|
| 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
|
|
