|
HC ZEPHYR 4.0 DELIVERY CATHETER
|
Facility
OP
|
$2,300.00
|
|
| Hospital Charge Code |
900800952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,265.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,358.84
|
| Rate for Payer: BCBS Transplant Transplant |
$1,380.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,124.70
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,725.00
|
| Rate for Payer: IEHP medi-cal |
$805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: Riverside University Health MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC ZEPHYR 4.0 ENDOBRONCHIAL VALVE
|
Facility
OP
|
$5,625.00
|
|
| Hospital Charge Code |
900800950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,093.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,093.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,568.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,133.12
|
| Rate for Payer: BCBS Transplant Transplant |
$3,375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,218.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,060.00
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,781.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,062.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,218.75
|
| Rate for Payer: IEHP medi-cal |
$1,968.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,751.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: Riverside University Health MISP |
$2,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,375.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,375.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,812.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,812.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,812.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,781.25
|
|
|
HC ZEPHYR 4.0 ENDOBRONCHIAL VALVE
|
Facility
IP
|
$5,625.00
|
|
| Hospital Charge Code |
900800950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: Blue Shield of California EPN |
$3,003.75
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,062.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,751.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
|
|
HC ZEPHYR 4.0 LP ENDOBRONCHIAL VALVE
|
Facility
IP
|
$5,625.00
|
|
| Hospital Charge Code |
900800951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: Blue Shield of California EPN |
$3,003.75
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,062.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,751.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
|
|
HC ZEPHYR 4.0 LP ENDOBRONCHIAL VALVE
|
Facility
OP
|
$5,625.00
|
|
| Hospital Charge Code |
900800951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,093.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,093.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,568.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,133.12
|
| Rate for Payer: BCBS Transplant Transplant |
$3,375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,218.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,060.00
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,781.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,062.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,218.75
|
| Rate for Payer: IEHP medi-cal |
$1,968.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,751.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: Riverside University Health MISP |
$2,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,375.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,375.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,812.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,812.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,812.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,781.25
|
|
|
HC ZEPHYR 5.5 DUAL MARK DELIVERY CATHETER
|
Facility
IP
|
$2,300.00
|
|
| Hospital Charge Code |
900800953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC ZEPHYR 5.5 DUAL MARK DELIVERY CATHETER
|
Facility
OP
|
$2,300.00
|
|
| Hospital Charge Code |
900800953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,265.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,358.84
|
| Rate for Payer: BCBS Transplant Transplant |
$1,380.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,124.70
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,725.00
|
| Rate for Payer: IEHP medi-cal |
$805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: Riverside University Health MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$10,425.83
|
|
|
Service Code
|
APR-DRG 0552
|
| Min. Negotiated Rate |
$8,748.95 |
| Max. Negotiated Rate |
$10,425.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,748.95
|
| Rate for Payer: IEHP medi-cal |
$10,425.83
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$7,401.25
|
|
|
Service Code
|
APR-DRG 0551
|
| Min. Negotiated Rate |
$6,210.84 |
| Max. Negotiated Rate |
$7,401.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,210.84
|
| Rate for Payer: IEHP medi-cal |
$7,401.25
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$27,604.22
|
|
|
Service Code
|
APR-DRG 0554
|
| Min. Negotiated Rate |
$23,164.38 |
| Max. Negotiated Rate |
$27,604.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,164.38
|
| Rate for Payer: IEHP medi-cal |
$27,604.22
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$15,623.39
|
|
|
Service Code
|
APR-DRG 0553
|
| Min. Negotiated Rate |
$13,110.54 |
| Max. Negotiated Rate |
$15,623.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,110.54
|
| Rate for Payer: IEHP medi-cal |
$15,623.39
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$124,941.73
|
|
|
Service Code
|
APR-DRG 0022
|
| Min. Negotiated Rate |
$104,846.21 |
| Max. Negotiated Rate |
$124,941.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$104,846.21
|
| Rate for Payer: IEHP medi-cal |
$124,941.73
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$107,107.97
|
|
|
Service Code
|
APR-DRG 0021
|
| Min. Negotiated Rate |
$89,880.82 |
| Max. Negotiated Rate |
$107,107.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$89,880.82
|
| Rate for Payer: IEHP medi-cal |
$107,107.97
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$272,258.09
|
|
|
Service Code
|
APR-DRG 0024
|
| Min. Negotiated Rate |
$228,468.32 |
| Max. Negotiated Rate |
$272,258.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$228,468.32
|
| Rate for Payer: IEHP medi-cal |
$272,258.09
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$168,360.21
|
|
|
Service Code
|
APR-DRG 0023
|
| Min. Negotiated Rate |
$141,281.29 |
| Max. Negotiated Rate |
$168,360.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$141,281.29
|
| Rate for Payer: IEHP medi-cal |
$168,360.21
|
|
|
HEART FAILURE
|
Facility
IP
|
$8,045.95
|
|
|
Service Code
|
APR-DRG 1942
|
| Min. Negotiated Rate |
$6,751.85 |
| Max. Negotiated Rate |
$8,045.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,751.85
|
| Rate for Payer: IEHP medi-cal |
$8,045.95
|
|
|
HEART FAILURE
|
Facility
IP
|
$11,129.25
|
|
|
Service Code
|
APR-DRG 1943
|
| Min. Negotiated Rate |
$9,339.23 |
| Max. Negotiated Rate |
$11,129.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,339.23
|
| Rate for Payer: IEHP medi-cal |
$11,129.25
|
|
|
HEART FAILURE
|
Facility
IP
|
$16,871.40
|
|
|
Service Code
|
APR-DRG 1944
|
| Min. Negotiated Rate |
$14,157.82 |
| Max. Negotiated Rate |
$16,871.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,157.82
|
| Rate for Payer: IEHP medi-cal |
$16,871.40
|
|
|
HEART FAILURE
|
Facility
IP
|
$6,130.57
|
|
|
Service Code
|
APR-DRG 1941
|
| Min. Negotiated Rate |
$5,144.53 |
| Max. Negotiated Rate |
$6,130.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,144.53
|
| Rate for Payer: IEHP medi-cal |
$6,130.57
|
|
|
HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION [218818]
|
Facility
IP
|
$12,167.51
|
|
|
Service Code
|
CPT J1640
|
| Hospital Charge Code |
ERX218818
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,433.50 |
| Max. Negotiated Rate |
$10,950.76 |
| Rate for Payer: Blue Shield of California Commercial |
$9,125.63
|
| Rate for Payer: Blue Shield of California EPN |
$6,497.45
|
| Rate for Payer: Cash Price |
$5,475.38
|
| Rate for Payer: Central Health Plan Commercial |
$9,734.01
|
| Rate for Payer: Cigna of CA HMO |
$8,517.26
|
| Rate for Payer: Cigna of CA PPO |
$8,517.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,867.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,867.00
|
| Rate for Payer: Galaxy Health WC |
$10,342.38
|
| Rate for Payer: Global Benefits Group Commercial |
$7,300.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,950.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,115.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,433.50
|
| Rate for Payer: Multiplan Commercial |
$9,125.63
|
| Rate for Payer: Networks By Design Commercial |
$6,083.76
|
| Rate for Payer: Prime Health Services Commercial |
$10,342.38
|
|
|
HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION [218818]
|
Facility
OP
|
$12,167.51
|
|
|
Service Code
|
CPT J1640
|
| Hospital Charge Code |
ERX218818
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$10,950.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$31.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.47
|
| Rate for Payer: BCBS Transplant Transplant |
$7,300.51
|
| Rate for Payer: Blue Shield of California Commercial |
$29.80
|
| Rate for Payer: Blue Shield of California EPN |
$27.09
|
| Rate for Payer: Caremore Medicare Advantage |
$31.35
|
| Rate for Payer: Cash Price |
$5,475.38
|
| Rate for Payer: Cash Price |
$5,475.38
|
| Rate for Payer: Central Health Plan Commercial |
$9,734.01
|
| Rate for Payer: Cigna of CA HMO |
$8,517.26
|
| Rate for Payer: Cigna of CA PPO |
$8,517.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.35
|
| Rate for Payer: Galaxy Health WC |
$10,342.38
|
| Rate for Payer: Global Benefits Group Commercial |
$7,300.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,950.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,125.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.41
|
| Rate for Payer: IEHP medi-cal |
$51.72
|
| Rate for Payer: IEHP Medicare Advantage |
$31.35
|
| Rate for Payer: Innovage PACE Commercial |
$47.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,115.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,433.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.01
|
| Rate for Payer: Multiplan Commercial |
$9,125.63
|
| Rate for Payer: Networks By Design Commercial |
$6,083.76
|
| Rate for Payer: Prime Health Services Commercial |
$10,342.38
|
| Rate for Payer: Prime Health Services Medicare |
$33.23
|
| Rate for Payer: Riverside University Health MISP |
$34.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,300.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,300.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,083.76
|
| Rate for Payer: United Healthcare All Other HMO |
$6,083.76
|
| Rate for Payer: United Healthcare HMO Rider |
$6,083.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,083.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.48
|
| Rate for Payer: Vantage Medical Group Senior |
$31.35
|
|
|
HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION
|
Facility
IP
|
$24,188.55
|
|
|
Service Code
|
APR-DRG 8104
|
| Min. Negotiated Rate |
$20,298.08 |
| Max. Negotiated Rate |
$24,188.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,298.08
|
| Rate for Payer: IEHP medi-cal |
$24,188.55
|
|
|
HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION
|
Facility
IP
|
$5,360.40
|
|
|
Service Code
|
APR-DRG 8101
|
| Min. Negotiated Rate |
$4,498.24 |
| Max. Negotiated Rate |
$5,360.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,498.24
|
| Rate for Payer: IEHP medi-cal |
$5,360.40
|
|
|
HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION
|
Facility
IP
|
$7,480.00
|
|
|
Service Code
|
APR-DRG 8102
|
| Min. Negotiated Rate |
$6,276.92 |
| Max. Negotiated Rate |
$7,480.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,276.92
|
| Rate for Payer: IEHP medi-cal |
$7,480.00
|
|
|
HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION
|
Facility
IP
|
$11,755.24
|
|
|
Service Code
|
APR-DRG 8103
|
| Min. Negotiated Rate |
$9,864.54 |
| Max. Negotiated Rate |
$11,755.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,864.54
|
| Rate for Payer: IEHP medi-cal |
$11,755.24
|
|
