|
KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY
|
Facility
IP
|
$16,442.93
|
|
|
Service Code
|
APR-DRG 4421
|
| Min. Negotiated Rate |
$13,798.26 |
| Max. Negotiated Rate |
$16,442.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,798.26
|
| Rate for Payer: IEHP medi-cal |
$16,442.93
|
|
|
KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY
|
Facility
IP
|
$39,496.94
|
|
|
Service Code
|
APR-DRG 4434
|
| Min. Negotiated Rate |
$33,144.29 |
| Max. Negotiated Rate |
$39,496.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$33,144.29
|
| Rate for Payer: IEHP medi-cal |
$39,496.94
|
|
|
KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY
|
Facility
IP
|
$13,841.48
|
|
|
Service Code
|
APR-DRG 4431
|
| Min. Negotiated Rate |
$11,615.23 |
| Max. Negotiated Rate |
$13,841.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,615.23
|
| Rate for Payer: IEHP medi-cal |
$13,841.48
|
|
|
KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY
|
Facility
IP
|
$16,027.83
|
|
|
Service Code
|
APR-DRG 4432
|
| Min. Negotiated Rate |
$13,449.92 |
| Max. Negotiated Rate |
$16,027.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,449.92
|
| Rate for Payer: IEHP medi-cal |
$16,027.83
|
|
|
KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY
|
Facility
IP
|
$23,567.89
|
|
|
Service Code
|
APR-DRG 4433
|
| Min. Negotiated Rate |
$19,777.25 |
| Max. Negotiated Rate |
$23,567.89 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,777.25
|
| Rate for Payer: IEHP medi-cal |
$23,567.89
|
|
|
Kidney-Heart Transplant
|
Facility
IP
|
$285,000.00
|
|
|
Service Code
|
MS-DRG 650
|
| Min. Negotiated Rate |
$282,500.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$282,500.00
|
|
|
Kidney-Heart Transplant
|
Facility
IP
|
$285,000.00
|
|
|
Service Code
|
MS-DRG 652
|
| Min. Negotiated Rate |
$282,500.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$282,500.00
|
|
|
Kidney-Heart Transplant
|
Facility
IP
|
$285,000.00
|
|
|
Service Code
|
MS-DRG 651
|
| Min. Negotiated Rate |
$282,500.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$282,500.00
|
|
|
Kidney-Heart Transplant
|
Facility
IP
|
$285,000.00
|
|
|
Service Code
|
MS-DRG 002
|
| Min. Negotiated Rate |
$282,500.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$282,500.00
|
|
|
Kidney-Heart Transplant
|
Facility
IP
|
$285,000.00
|
|
|
Service Code
|
MS-DRG 001
|
| Min. Negotiated Rate |
$282,500.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$282,500.00
|
|
|
Kidney-Liver Transplant
|
Facility
IP
|
$285,000.00
|
|
|
Service Code
|
MS-DRG 650
|
| Min. Negotiated Rate |
$226,000.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: BCBS Transplant Transplant |
$258,280.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$226,000.00
|
|
|
Kidney-Liver Transplant
|
Facility
IP
|
$285,000.00
|
|
|
Service Code
|
MS-DRG 651
|
| Min. Negotiated Rate |
$226,000.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: BCBS Transplant Transplant |
$258,280.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$226,000.00
|
|
|
Kidney-Liver Transplant
|
Facility
IP
|
$285,000.00
|
|
|
Service Code
|
MS-DRG 652
|
| Min. Negotiated Rate |
$226,000.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: BCBS Transplant Transplant |
$258,280.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$226,000.00
|
|
|
Kidney-Liver Transplant
|
Facility
IP
|
$285,000.00
|
|
|
Service Code
|
MS-DRG 006
|
| Min. Negotiated Rate |
$226,000.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: BCBS Transplant Transplant |
$258,280.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$226,000.00
|
|
|
Kidney-Liver Transplant
|
Facility
IP
|
$285,000.00
|
|
|
Service Code
|
MS-DRG 005
|
| Min. Negotiated Rate |
$226,000.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: BCBS Transplant Transplant |
$258,280.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$226,000.00
|
|
|
KIDNEY TRANSPLANT
|
Facility
IP
|
$117,275.81
|
|
|
Service Code
|
APR-DRG 4404
|
| Min. Negotiated Rate |
$85,811.57 |
| Max. Negotiated Rate |
$117,275.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$85,811.57
|
| Rate for Payer: IEHP medi-cal |
$117,275.81
|
|
|
KIDNEY TRANSPLANT
|
Facility
IP
|
$77,304.19
|
|
|
Service Code
|
APR-DRG 4403
|
| Min. Negotiated Rate |
$56,564.04 |
| Max. Negotiated Rate |
$77,304.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$56,564.04
|
| Rate for Payer: IEHP medi-cal |
$77,304.19
|
|
|
KIDNEY TRANSPLANT
|
Facility
IP
|
$66,300.97
|
|
|
Service Code
|
APR-DRG 4402
|
| Min. Negotiated Rate |
$48,512.90 |
| Max. Negotiated Rate |
$66,300.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$48,512.90
|
| Rate for Payer: IEHP medi-cal |
$66,300.97
|
|
|
KIDNEY TRANSPLANT
|
Facility
IP
|
$59,202.77
|
|
|
Service Code
|
APR-DRG 4401
|
| Min. Negotiated Rate |
$43,319.10 |
| Max. Negotiated Rate |
$59,202.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$43,319.10
|
| Rate for Payer: IEHP medi-cal |
$59,202.77
|
|
|
KIT FOR PREPARATION OF GA-68-GOZETOTIDE 25 MCG INTRAVENOUS SOLUTION [233443]
|
Facility
OP
|
$5,640.00
|
|
|
Service Code
|
CPT A9596
|
| Hospital Charge Code |
ERX233443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$991.68 |
| Max. Negotiated Rate |
$5,744.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$991.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,744.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,239.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,090.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,090.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,860.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,036.90
|
| Rate for Payer: BCBS Transplant Transplant |
$3,384.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,547.56
|
| Rate for Payer: Blue Shield of California EPN |
$2,757.96
|
| Rate for Payer: Caremore Medicare Advantage |
$991.68
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,512.00
|
| Rate for Payer: Cigna of CA HMO |
$3,948.00
|
| Rate for Payer: Cigna of CA PPO |
$3,948.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,239.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,338.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$991.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$991.68
|
| Rate for Payer: Galaxy Health WC |
$4,794.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,384.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,076.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,230.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,626.36
|
| Rate for Payer: IEHP medi-cal |
$1,636.27
|
| Rate for Payer: IEHP Medicare Advantage |
$991.68
|
| Rate for Payer: Innovage PACE Commercial |
$1,487.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,761.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,328.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,328.85
|
| Rate for Payer: Multiplan Commercial |
$4,230.00
|
| Rate for Payer: Networks By Design Commercial |
$2,820.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,794.00
|
| Rate for Payer: Prime Health Services Medicare |
$1,051.18
|
| Rate for Payer: Riverside University Health MISP |
$1,090.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,384.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,384.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,820.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,820.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,820.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,239.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,090.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,090.85
|
|
|
KIT FOR PREPARATION OF GA-68-GOZETOTIDE 25 MCG INTRAVENOUS SOLUTION [233443]
|
Facility
IP
|
$5,640.00
|
|
|
Service Code
|
CPT A9596
|
| Hospital Charge Code |
ERX233443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,128.00 |
| Max. Negotiated Rate |
$5,076.00 |
| Rate for Payer: Blue Shield of California Commercial |
$4,230.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,011.76
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,512.00
|
| Rate for Payer: Cigna of CA HMO |
$3,948.00
|
| Rate for Payer: Cigna of CA PPO |
$3,948.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,256.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,256.00
|
| Rate for Payer: Galaxy Health WC |
$4,794.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,384.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,076.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,761.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Multiplan Commercial |
$4,230.00
|
| Rate for Payer: Networks By Design Commercial |
$2,820.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,794.00
|
|
|
KIT FOR PREPARATION OF TC-99M-MEDRONATE SODIUM 25 MG IV SOLUTION [121677]
|
Facility
OP
|
$15.60
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
ERX121677
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$293.20 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$267.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.20
|
| Rate for Payer: BCBS Transplant Transplant |
$9.36
|
| Rate for Payer: Blue Shield of California Commercial |
$9.64
|
| Rate for Payer: Blue Shield of California EPN |
$7.58
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Central Health Plan Commercial |
$12.48
|
| Rate for Payer: Cigna of CA HMO |
$9.98
|
| Rate for Payer: Cigna of CA PPO |
$11.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$13.26
|
| Rate for Payer: Global Benefits Group Commercial |
$9.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.70
|
| Rate for Payer: IEHP medi-cal |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$13.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.36
|
| Rate for Payer: Riverside University Health MISP |
$6.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.80
|
| Rate for Payer: United Healthcare All Other HMO |
$7.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$13.26
|
|
|
KIT FOR PREPARATION OF TC-99M-MEDRONATE SODIUM 25 MG IV SOLUTION [121677]
|
Facility
IP
|
$15.60
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
ERX121677
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.04 |
| Rate for Payer: Blue Shield of California Commercial |
$11.70
|
| Rate for Payer: Blue Shield of California EPN |
$8.33
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Central Health Plan Commercial |
$12.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$13.26
|
| Rate for Payer: Global Benefits Group Commercial |
$9.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$13.26
|
|
|
KIT FOR PREP TC-99M-MERTIATIDE (BETIATIDE) 1 MG INTRAVENOUS SOLUTION [225273]
|
Facility
OP
|
$498.77
|
|
|
Service Code
|
CPT A9562
|
| Hospital Charge Code |
ERX225273
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$893.87 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$423.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$274.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$274.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$816.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$893.87
|
| Rate for Payer: BCBS Transplant Transplant |
$299.26
|
| Rate for Payer: Blue Shield of California Commercial |
$308.24
|
| Rate for Payer: Blue Shield of California EPN |
$242.40
|
| Rate for Payer: Cash Price |
$224.45
|
| Rate for Payer: Cash Price |
$224.45
|
| Rate for Payer: Central Health Plan Commercial |
$399.02
|
| Rate for Payer: Cigna of CA HMO |
$319.21
|
| Rate for Payer: Cigna of CA PPO |
$369.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$423.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.51
|
| Rate for Payer: Galaxy Health WC |
$423.95
|
| Rate for Payer: Global Benefits Group Commercial |
$299.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$448.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$374.08
|
| Rate for Payer: IEHP medi-cal |
$174.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$374.08
|
| Rate for Payer: Networks By Design Commercial |
$324.20
|
| Rate for Payer: Prime Health Services Commercial |
$423.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$299.26
|
| Rate for Payer: Riverside University Health MISP |
$199.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$249.38
|
| Rate for Payer: United Healthcare All Other HMO |
$249.38
|
| Rate for Payer: United Healthcare HMO Rider |
$249.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$423.95
|
| Rate for Payer: Vantage Medical Group Senior |
$423.95
|
|
|
KIT FOR PREP TC-99M-MERTIATIDE (BETIATIDE) 1 MG INTRAVENOUS SOLUTION [225273]
|
Facility
IP
|
$498.77
|
|
|
Service Code
|
CPT A9562
|
| Hospital Charge Code |
ERX225273
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$448.89 |
| Rate for Payer: Blue Shield of California Commercial |
$374.08
|
| Rate for Payer: Blue Shield of California EPN |
$266.34
|
| Rate for Payer: Cash Price |
$224.45
|
| Rate for Payer: Central Health Plan Commercial |
$399.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.51
|
| Rate for Payer: Galaxy Health WC |
$423.95
|
| Rate for Payer: Global Benefits Group Commercial |
$299.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$448.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$374.08
|
| Rate for Payer: Networks By Design Commercial |
$324.20
|
| Rate for Payer: Prime Health Services Commercial |
$423.95
|
|
