|
LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN [233901]
|
Facility
|
OP
|
$52,020.00
|
|
|
Service Code
|
HCPCS A9607
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$267.32 |
| Max. Negotiated Rate |
$46,818.00 |
| Rate for Payer: Adventist Health Commercial |
$10,404.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$267.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,488.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$420.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.82
|
| Rate for Payer: Blue Shield of California Commercial |
$32,772.60
|
| Rate for Payer: Blue Shield of California EPN |
$20,651.94
|
| Rate for Payer: Cash Price |
$23,409.00
|
| Rate for Payer: Cash Price |
$23,409.00
|
| Rate for Payer: Central Health Plan Commercial |
$41,616.00
|
| Rate for Payer: Cigna of CA HMO |
$33,292.80
|
| Rate for Payer: Cigna of CA PPO |
$38,494.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$294.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,414.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.08
|
| Rate for Payer: EPIC Health Plan Senior |
$294.05
|
| Rate for Payer: Galaxy Health WC |
$44,217.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31,212.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$46,818.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$438.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$427.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,032.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$471.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,404.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$358.21
|
| Rate for Payer: Multiplan Commercial |
$39,015.00
|
| Rate for Payer: Networks By Design Commercial |
$33,813.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$267.32
|
| Rate for Payer: Prime Health Services Commercial |
$44,217.00
|
| Rate for Payer: Prime Health Services Medicare |
$283.36
|
| Rate for Payer: Riverside University Health System MISP |
$294.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,212.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31,212.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,523.11
|
| Rate for Payer: United Healthcare All Other HMO |
$19,002.91
|
| Rate for Payer: United Healthcare HMO Rider |
$18,591.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,036.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$334.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.05
|
| Rate for Payer: Vantage Medical Group Senior |
$294.05
|
|
|
LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN [233901]
|
Facility
|
IP
|
$52,020.00
|
|
|
Service Code
|
HCPCS A9607
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$10,404.00 |
| Max. Negotiated Rate |
$46,818.00 |
| Rate for Payer: Adventist Health Commercial |
$10,404.00
|
| Rate for Payer: Blue Shield of California Commercial |
$41,720.04
|
| Rate for Payer: Blue Shield of California EPN |
$26,218.08
|
| Rate for Payer: Cash Price |
$23,409.00
|
| Rate for Payer: Central Health Plan Commercial |
$41,616.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,414.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,808.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,808.00
|
| Rate for Payer: Galaxy Health WC |
$44,217.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31,212.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$46,818.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,032.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,691.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,404.00
|
| Rate for Payer: Multiplan Commercial |
$39,015.00
|
| Rate for Payer: Networks By Design Commercial |
$33,813.00
|
| Rate for Payer: Prime Health Services Commercial |
$44,217.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,523.11
|
| Rate for Payer: United Healthcare All Other HMO |
$19,002.91
|
| Rate for Payer: United Healthcare HMO Rider |
$18,591.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,036.55
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$12,878.73
|
|
|
Service Code
|
APR-DRG 6942
|
| Min. Negotiated Rate |
$8,133.94 |
| Max. Negotiated Rate |
$12,878.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,133.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,692.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,878.73
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$31,324.69
|
|
|
Service Code
|
APR-DRG 6944
|
| Min. Negotiated Rate |
$19,784.02 |
| Max. Negotiated Rate |
$31,324.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,784.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,575.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,324.69
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$9,406.27
|
|
|
Service Code
|
APR-DRG 6941
|
| Min. Negotiated Rate |
$5,940.80 |
| Max. Negotiated Rate |
$9,406.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,940.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,079.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,406.27
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$19,040.15
|
|
|
Service Code
|
APR-DRG 6943
|
| Min. Negotiated Rate |
$12,025.36 |
| Max. Negotiated Rate |
$19,040.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,025.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,330.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,040.15
|
|
|
LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION [10475]
|
Facility
|
IP
|
$1,339.22
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$1,205.30 |
| Rate for Payer: Adventist Health Commercial |
$267.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,074.05
|
| Rate for Payer: Blue Shield of California EPN |
$674.97
|
| Rate for Payer: Cash Price |
$602.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,071.38
|
| Rate for Payer: Cigna of CA HMO |
$937.45
|
| Rate for Payer: Cigna of CA PPO |
$937.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$937.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.69
|
| Rate for Payer: EPIC Health Plan Senior |
$535.69
|
| Rate for Payer: Galaxy Health WC |
$1,138.34
|
| Rate for Payer: Global Benefits Group Commercial |
$803.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,205.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$850.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$790.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.84
|
| Rate for Payer: Multiplan Commercial |
$1,004.41
|
| Rate for Payer: Networks By Design Commercial |
$669.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$502.61
|
| Rate for Payer: United Healthcare All Other HMO |
$489.22
|
| Rate for Payer: United Healthcare HMO Rider |
$478.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$438.59
|
|
|
LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION [10475]
|
Facility
|
OP
|
$1,339.22
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$27,120.10 |
| Rate for Payer: Adventist Health Commercial |
$267.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$5,548.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,120.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,323.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,103.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,548.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$503.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$628.94
|
| Rate for Payer: Blue Shield of California Commercial |
$5,532.86
|
| Rate for Payer: Blue Shield of California EPN |
$5,029.87
|
| Rate for Payer: Cash Price |
$602.65
|
| Rate for Payer: Cash Price |
$602.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,071.38
|
| Rate for Payer: Cigna of CA HMO |
$937.45
|
| Rate for Payer: Cigna of CA PPO |
$937.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,103.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,103.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$937.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,155.78
|
| Rate for Payer: EPIC Health Plan Senior |
$6,103.86
|
| Rate for Payer: Galaxy Health WC |
$1,138.34
|
| Rate for Payer: Global Benefits Group Commercial |
$803.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,205.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9,100.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,548.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,548.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$850.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$486.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,768.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,435.61
|
| Rate for Payer: Multiplan Commercial |
$1,004.41
|
| Rate for Payer: Networks By Design Commercial |
$669.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,548.96
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.34
|
| Rate for Payer: Prime Health Services Medicare |
$5,881.90
|
| Rate for Payer: Riverside University Health System MISP |
$6,103.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$803.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$502.61
|
| Rate for Payer: United Healthcare All Other HMO |
$489.22
|
| Rate for Payer: United Healthcare HMO Rider |
$478.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$438.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,548.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,103.86
|
| Rate for Payer: Vantage Medical Group Senior |
$6,103.86
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$58,917.71
|
|
|
Service Code
|
MSDRG 821
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$58,917.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58,917.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38,058.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53,283.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,431.19
|
| Rate for Payer: EPIC Health Plan Senior |
$34,954.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,776.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44,487.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42,580.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31,776.48
|
| Rate for Payer: Prime Health Services Medicare |
$33,683.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$154,355.67
|
|
|
Service Code
|
MSDRG 820
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$154,355.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154,355.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99,707.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139,593.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$134,952.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89,968.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$81,789.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114,504.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109,597.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$81,789.21
|
| Rate for Payer: Prime Health Services Medicare |
$86,696.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,688.08
|
|
|
Service Code
|
MSDRG 822
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$31,688.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,688.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,469.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,657.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,886.93
|
| Rate for Payer: EPIC Health Plan Senior |
$19,257.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,507.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,510.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,459.69
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,507.23
|
| Rate for Payer: Prime Health Services Medicare |
$18,557.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$42,936.82
|
|
|
Service Code
|
MSDRG 841
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$42,936.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,936.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,735.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38,830.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$25,742.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,401.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,762.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,358.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,401.94
|
| Rate for Payer: Prime Health Services Medicare |
$24,806.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$85,139.33
|
|
|
Service Code
|
MSDRG 840
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$85,139.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85,139.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54,996.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76,997.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$75,103.84
|
| Rate for Payer: EPIC Health Plan Senior |
$50,069.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$45,517.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63,724.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60,993.42
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$45,517.48
|
| Rate for Payer: Prime Health Services Medicare |
$48,248.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC
|
Facility
|
IP
|
$59,628.33
|
|
|
Service Code
|
MSDRG 824
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$59,628.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59,628.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38,517.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53,925.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$53,045.64
|
| Rate for Payer: EPIC Health Plan Senior |
$35,363.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,148.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45,008.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43,079.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32,148.87
|
| Rate for Payer: Prime Health Services Medicare |
$34,077.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC
|
Facility
|
IP
|
$120,667.35
|
|
|
Service Code
|
MSDRG 823
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$120,667.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$120,667.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$77,946.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109,127.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$105,823.38
|
| Rate for Payer: EPIC Health Plan Senior |
$70,548.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64,135.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89,789.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$85,941.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$64,135.38
|
| Rate for Payer: Prime Health Services Medicare |
$67,983.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$35,514.86
|
|
|
Service Code
|
MSDRG 825
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$35,514.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,514.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,941.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32,118.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,195.77
|
| Rate for Payer: EPIC Health Plan Senior |
$21,463.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,512.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,317.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,146.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19,512.59
|
| Rate for Payer: Prime Health Services Medicare |
$20,683.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$26,592.72
|
|
|
Service Code
|
MSDRG 842
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$26,592.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,592.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,177.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,049.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,481.20
|
| Rate for Payer: EPIC Health Plan Senior |
$16,320.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,837.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,771.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,881.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,837.09
|
| Rate for Payer: Prime Health Services Medicare |
$15,727.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$28,585.39
|
|
|
Service Code
|
APR-DRG 6913
|
| Min. Negotiated Rate |
$18,053.93 |
| Max. Negotiated Rate |
$28,585.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,053.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,514.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,585.39
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$13,680.38
|
|
|
Service Code
|
APR-DRG 6911
|
| Min. Negotiated Rate |
$8,640.24 |
| Max. Negotiated Rate |
$13,680.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,640.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,296.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,680.38
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$18,943.46
|
|
|
Service Code
|
APR-DRG 6912
|
| Min. Negotiated Rate |
$11,964.29 |
| Max. Negotiated Rate |
$18,943.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,964.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,257.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,943.46
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$50,532.00
|
|
|
Service Code
|
APR-DRG 6914
|
| Min. Negotiated Rate |
$31,914.95 |
| Max. Negotiated Rate |
$50,532.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$31,914.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38,031.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50,532.00
|
|
|
MACITENTAN 10 MG TABLET [203952]
|
Facility
|
OP
|
$532.71
|
|
|
Service Code
|
NDC 6621550115
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$106.54 |
| Max. Negotiated Rate |
$479.44 |
| Rate for Payer: Adventist Health Commercial |
$106.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$323.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$292.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$399.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$257.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.88
|
| Rate for Payer: Blue Shield of California Commercial |
$337.74
|
| Rate for Payer: Blue Shield of California EPN |
$212.55
|
| Rate for Payer: Cash Price |
$239.72
|
| Rate for Payer: Central Health Plan Commercial |
$426.17
|
| Rate for Payer: Cigna of CA HMO |
$372.90
|
| Rate for Payer: Cigna of CA PPO |
$372.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$452.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$452.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$372.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.08
|
| Rate for Payer: EPIC Health Plan Senior |
$213.08
|
| Rate for Payer: Galaxy Health WC |
$452.80
|
| Rate for Payer: Global Benefits Group Commercial |
$319.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$479.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$338.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.90
|
| Rate for Payer: Multiplan Commercial |
$399.53
|
| Rate for Payer: Networks By Design Commercial |
$346.26
|
| Rate for Payer: Prime Health Services Commercial |
$452.80
|
| Rate for Payer: Riverside University Health System MISP |
$213.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$319.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.36
|
| Rate for Payer: United Healthcare All Other HMO |
$266.36
|
| Rate for Payer: United Healthcare HMO Rider |
$266.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$452.80
|
| Rate for Payer: Vantage Medical Group Senior |
$452.80
|
|
|
MACITENTAN 10 MG TABLET [203952]
|
Facility
|
IP
|
$532.71
|
|
|
Service Code
|
NDC 6621550115
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$106.54 |
| Max. Negotiated Rate |
$479.44 |
| Rate for Payer: Adventist Health Commercial |
$106.54
|
| Rate for Payer: Blue Shield of California Commercial |
$427.23
|
| Rate for Payer: Blue Shield of California EPN |
$268.49
|
| Rate for Payer: Cash Price |
$239.72
|
| Rate for Payer: Central Health Plan Commercial |
$426.17
|
| Rate for Payer: Cigna of CA HMO |
$372.90
|
| Rate for Payer: Cigna of CA PPO |
$372.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$372.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.08
|
| Rate for Payer: EPIC Health Plan Senior |
$213.08
|
| Rate for Payer: Galaxy Health WC |
$452.80
|
| Rate for Payer: Global Benefits Group Commercial |
$319.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$479.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$338.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.54
|
| Rate for Payer: Multiplan Commercial |
$399.53
|
| Rate for Payer: Networks By Design Commercial |
$346.26
|
| Rate for Payer: Prime Health Services Commercial |
$452.80
|
|
|
MACITENTAN 10 MG TABLET [203952]
|
Facility
|
OP
|
$532.71
|
|
|
Service Code
|
NDC 6621550130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$106.54 |
| Max. Negotiated Rate |
$479.44 |
| Rate for Payer: Adventist Health Commercial |
$106.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$323.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$292.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$399.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$257.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.88
|
| Rate for Payer: Blue Shield of California Commercial |
$337.74
|
| Rate for Payer: Blue Shield of California EPN |
$212.55
|
| Rate for Payer: Cash Price |
$239.72
|
| Rate for Payer: Central Health Plan Commercial |
$426.17
|
| Rate for Payer: Cigna of CA HMO |
$372.90
|
| Rate for Payer: Cigna of CA PPO |
$372.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$452.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$452.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$372.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.08
|
| Rate for Payer: EPIC Health Plan Senior |
$213.08
|
| Rate for Payer: Galaxy Health WC |
$452.80
|
| Rate for Payer: Global Benefits Group Commercial |
$319.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$479.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$338.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.90
|
| Rate for Payer: Multiplan Commercial |
$399.53
|
| Rate for Payer: Networks By Design Commercial |
$346.26
|
| Rate for Payer: Prime Health Services Commercial |
$452.80
|
| Rate for Payer: Riverside University Health System MISP |
$213.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$319.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.36
|
| Rate for Payer: United Healthcare All Other HMO |
$266.36
|
| Rate for Payer: United Healthcare HMO Rider |
$266.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$452.80
|
| Rate for Payer: Vantage Medical Group Senior |
$452.80
|
|
|
MACITENTAN 10 MG TABLET [203952]
|
Facility
|
IP
|
$532.71
|
|
|
Service Code
|
NDC 6621550130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$106.54 |
| Max. Negotiated Rate |
$479.44 |
| Rate for Payer: Adventist Health Commercial |
$106.54
|
| Rate for Payer: Blue Shield of California Commercial |
$427.23
|
| Rate for Payer: Blue Shield of California EPN |
$268.49
|
| Rate for Payer: Cash Price |
$239.72
|
| Rate for Payer: Central Health Plan Commercial |
$426.17
|
| Rate for Payer: Cigna of CA HMO |
$372.90
|
| Rate for Payer: Cigna of CA PPO |
$372.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$372.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.08
|
| Rate for Payer: EPIC Health Plan Senior |
$213.08
|
| Rate for Payer: Galaxy Health WC |
$452.80
|
| Rate for Payer: Global Benefits Group Commercial |
$319.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$479.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$338.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.54
|
| Rate for Payer: Multiplan Commercial |
$399.53
|
| Rate for Payer: Networks By Design Commercial |
$346.26
|
| Rate for Payer: Prime Health Services Commercial |
$452.80
|
|
