|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$18,174.41
|
|
|
Service Code
|
APR-DRG 1134
|
| Min. Negotiated Rate |
$11,478.58 |
| Max. Negotiated Rate |
$18,174.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,478.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,678.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,174.41
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$11,112.49
|
|
|
Service Code
|
APR-DRG 1133
|
| Min. Negotiated Rate |
$7,018.42 |
| Max. Negotiated Rate |
$11,112.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,018.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,363.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,112.49
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$7,627.64
|
|
|
Service Code
|
APR-DRG 1132
|
| Min. Negotiated Rate |
$4,817.46 |
| Max. Negotiated Rate |
$7,627.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,817.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,740.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,627.64
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$23,289.08
|
|
|
Service Code
|
APR-DRG 7102
|
| Min. Negotiated Rate |
$14,708.89 |
| Max. Negotiated Rate |
$23,289.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,708.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,528.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,289.08
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$16,099.48
|
|
|
Service Code
|
APR-DRG 7101
|
| Min. Negotiated Rate |
$10,168.09 |
| Max. Negotiated Rate |
$16,099.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,168.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,116.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,099.48
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$70,372.68
|
|
|
Service Code
|
APR-DRG 7104
|
| Min. Negotiated Rate |
$44,445.90 |
| Max. Negotiated Rate |
$70,372.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$44,445.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52,964.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70,372.68
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$38,157.76
|
|
|
Service Code
|
APR-DRG 7103
|
| Min. Negotiated Rate |
$24,099.64 |
| Max. Negotiated Rate |
$38,157.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$24,099.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28,718.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38,157.76
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$16,092.37
|
|
|
Service Code
|
APR-DRG 2453
|
| Min. Negotiated Rate |
$10,163.60 |
| Max. Negotiated Rate |
$16,092.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,163.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,111.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,092.37
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$11,217.14
|
|
|
Service Code
|
APR-DRG 2452
|
| Min. Negotiated Rate |
$7,084.51 |
| Max. Negotiated Rate |
$11,217.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,084.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,442.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,217.14
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$28,118.21
|
|
|
Service Code
|
APR-DRG 2454
|
| Min. Negotiated Rate |
$17,758.87 |
| Max. Negotiated Rate |
$28,118.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,758.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,162.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,118.21
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$8,794.59
|
|
|
Service Code
|
APR-DRG 2451
|
| Min. Negotiated Rate |
$5,554.48 |
| Max. Negotiated Rate |
$8,794.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,554.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,619.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,794.59
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
1757347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Shield of California Commercial |
$427.50
|
| Rate for Payer: Blue Shield of California EPN |
$304.38
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.23
|
| Rate for Payer: United Healthcare All Other HMO |
$210.22
|
| Rate for Payer: United Healthcare HMO Rider |
$205.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.10
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
1757347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$32.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.79
|
| Rate for Payer: Blue Distinction Transplant |
$342.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.15
|
| Rate for Payer: Blue Shield of California EPN |
$140.14
|
| Rate for Payer: Caremore Medicare Advantage |
$32.16
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.24
|
| Rate for Payer: Dignity Health Media |
$32.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.16
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$427.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$52.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32.16
|
| Rate for Payer: InnovAge PACE Commercial |
$48.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.10
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Prime Health Services Medicare |
$34.09
|
| Rate for Payer: Riverside University Health System MISP |
$35.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.00
|
| Rate for Payer: United Healthcare All Other HMO |
$285.00
|
| Rate for Payer: United Healthcare HMO Rider |
$285.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.38
|
| Rate for Payer: Vantage Medical Group Senior |
$32.16
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
|
IP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-99
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$813.66 |
| Rate for Payer: Blue Shield of California Commercial |
$678.05
|
| Rate for Payer: Blue Shield of California EPN |
$482.77
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Central Health Plan Commercial |
$723.26
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$361.63
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.81
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.38
|
| Rate for Payer: United Healthcare All Other HMO |
$333.42
|
| Rate for Payer: United Healthcare HMO Rider |
$326.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$298.34
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
|
IP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-01
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$813.66 |
| Rate for Payer: Blue Shield of California Commercial |
$678.05
|
| Rate for Payer: Blue Shield of California EPN |
$482.77
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Central Health Plan Commercial |
$723.26
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$361.63
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.81
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.38
|
| Rate for Payer: United Healthcare All Other HMO |
$333.42
|
| Rate for Payer: United Healthcare HMO Rider |
$326.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$298.34
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
|
OP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-01
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$813.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$549.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$768.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$437.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$534.12
|
| Rate for Payer: Blue Distinction Transplant |
$542.44
|
| Rate for Payer: Blue Shield of California Commercial |
$568.66
|
| Rate for Payer: Blue Shield of California EPN |
$442.09
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Central Health Plan Commercial |
$723.26
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$768.46
|
| Rate for Payer: Dignity Health Media |
$768.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$361.63
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.66
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$678.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$316.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.81
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: Riverside University Health System MISP |
$361.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$452.04
|
| Rate for Payer: United Healthcare All Other HMO |
$452.04
|
| Rate for Payer: United Healthcare HMO Rider |
$452.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.46
|
| Rate for Payer: Vantage Medical Group Senior |
$768.46
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
|
OP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-99
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$813.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$549.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$768.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$437.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$534.12
|
| Rate for Payer: Blue Distinction Transplant |
$542.44
|
| Rate for Payer: Blue Shield of California Commercial |
$568.66
|
| Rate for Payer: Blue Shield of California EPN |
$442.09
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Central Health Plan Commercial |
$723.26
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$768.46
|
| Rate for Payer: Dignity Health Media |
$768.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$361.63
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.66
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$678.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$316.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.81
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: Riverside University Health System MISP |
$361.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$452.04
|
| Rate for Payer: United Healthcare All Other HMO |
$452.04
|
| Rate for Payer: United Healthcare HMO Rider |
$452.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.46
|
| Rate for Payer: Vantage Medical Group Senior |
$768.46
|
|
|
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 |
$227.11 |
| Max. Negotiated Rate |
$1,021.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$689.61
|
| 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 Exchange |
$549.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$670.88
|
| Rate for Payer: Blue Distinction Transplant |
$681.32
|
| Rate for Payer: Blue Shield of California Commercial |
$714.25
|
| Rate for Payer: Blue Shield of California EPN |
$555.28
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Central Health Plan Commercial |
$908.43
|
| 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 Management Network EPO/PPO |
$1,021.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$851.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$397.44
|
| 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 |
$227.11
|
| Rate for Payer: Multiplan Commercial |
$851.66
|
| Rate for Payer: Networks By Design Commercial |
$567.77
|
| Rate for Payer: Prime Health Services Commercial |
$965.21
|
| Rate for Payer: Riverside University Health System MISP |
$454.22
|
| 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 Medi-Cal |
$965.21
|
| Rate for Payer: Vantage Medical Group Senior |
$965.21
|
|
|
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 |
$227.11 |
| Max. Negotiated Rate |
$1,021.99 |
| Rate for Payer: Blue Shield of California Commercial |
$851.66
|
| Rate for Payer: Blue Shield of California EPN |
$606.38
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Central Health Plan Commercial |
$908.43
|
| 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: Health Management Network EPO/PPO |
$1,021.99
|
| 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 |
$227.11
|
| Rate for Payer: Multiplan Commercial |
$851.66
|
| 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
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$18,236.48
|
|
|
Service Code
|
APR-DRG 2282
|
| Min. Negotiated Rate |
$11,517.78 |
| Max. Negotiated Rate |
$18,236.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,517.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,725.35
|
| 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 |
$26,982.73 |
| Max. Negotiated Rate |
$42,722.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,982.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32,154.42
|
| 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 |
$15,684.48 |
| Max. Negotiated Rate |
$24,833.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,684.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,690.67
|
| 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 |
$8,931.52 |
| Max. Negotiated Rate |
$14,141.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,931.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,643.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,141.57
|
|
|
Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)
|
Facility
|
OP
|
$4,846.00
|
|
|
Service Code
|
CPT 64520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| 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/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| 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
|
|
|
Injection, anesthetic agent; stellate ganglion (cervical sympathetic)
|
Facility
|
OP
|
$4,846.00
|
|
|
Service Code
|
CPT 64510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$115.29 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| 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/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| 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
|
|
