|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
IP
|
$943.82
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.76 |
| Max. Negotiated Rate |
$849.44 |
| Rate for Payer: Adventist Health Commercial |
$188.76
|
| Rate for Payer: Blue Shield of California Commercial |
$756.94
|
| Rate for Payer: Blue Shield of California EPN |
$475.69
|
| Rate for Payer: Cash Price |
$424.72
|
| Rate for Payer: Central Health Plan Commercial |
$755.06
|
| Rate for Payer: Cigna of CA HMO |
$660.67
|
| Rate for Payer: Cigna of CA PPO |
$660.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.53
|
| Rate for Payer: EPIC Health Plan Senior |
$377.53
|
| Rate for Payer: Galaxy Health WC |
$802.25
|
| Rate for Payer: Global Benefits Group Commercial |
$566.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$599.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$556.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.76
|
| Rate for Payer: Multiplan Commercial |
$707.87
|
| Rate for Payer: Networks By Design Commercial |
$471.91
|
| Rate for Payer: Prime Health Services Commercial |
$802.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.22
|
| Rate for Payer: United Healthcare All Other HMO |
$344.78
|
| Rate for Payer: United Healthcare HMO Rider |
$337.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.10
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
OP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$364.59 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$34.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.19
|
| Rate for Payer: Blue Shield of California Commercial |
$41.99
|
| Rate for Payer: Blue Shield of California EPN |
$38.17
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.08
|
| Rate for Payer: Cigna of CA HMO |
$283.57
|
| Rate for Payer: Cigna of CA PPO |
$283.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.46
|
| Rate for Payer: EPIC Health Plan Senior |
$37.64
|
| Rate for Payer: Galaxy Health WC |
$344.33
|
| Rate for Payer: Global Benefits Group Commercial |
$243.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$56.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.85
|
| Rate for Payer: Multiplan Commercial |
$303.82
|
| Rate for Payer: Networks By Design Commercial |
$202.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$34.22
|
| Rate for Payer: Prime Health Services Commercial |
$344.33
|
| Rate for Payer: Prime Health Services Medicare |
$36.27
|
| Rate for Payer: Riverside University Health System MISP |
$37.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.03
|
| Rate for Payer: United Healthcare All Other HMO |
$147.98
|
| Rate for Payer: United Healthcare HMO Rider |
$144.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$34.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Vantage Medical Group Senior |
$37.64
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
IP
|
$405.10
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$364.59 |
| Rate for Payer: Adventist Health Commercial |
$81.02
|
| Rate for Payer: Blue Shield of California Commercial |
$324.89
|
| Rate for Payer: Blue Shield of California EPN |
$204.17
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.08
|
| Rate for Payer: Cigna of CA HMO |
$283.57
|
| Rate for Payer: Cigna of CA PPO |
$283.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.04
|
| Rate for Payer: EPIC Health Plan Senior |
$162.04
|
| Rate for Payer: Galaxy Health WC |
$344.33
|
| Rate for Payer: Global Benefits Group Commercial |
$243.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.02
|
| Rate for Payer: Multiplan Commercial |
$303.82
|
| Rate for Payer: Networks By Design Commercial |
$202.55
|
| Rate for Payer: Prime Health Services Commercial |
$344.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.03
|
| Rate for Payer: United Healthcare All Other HMO |
$147.98
|
| Rate for Payer: United Healthcare HMO Rider |
$144.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.67
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
IP
|
$540.38
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$486.34 |
| Rate for Payer: Adventist Health Commercial |
$108.08
|
| Rate for Payer: Blue Shield of California Commercial |
$433.38
|
| Rate for Payer: Blue Shield of California EPN |
$272.35
|
| Rate for Payer: Cash Price |
$243.17
|
| Rate for Payer: Central Health Plan Commercial |
$432.30
|
| Rate for Payer: Cigna of CA HMO |
$378.27
|
| Rate for Payer: Cigna of CA PPO |
$378.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.15
|
| Rate for Payer: EPIC Health Plan Senior |
$216.15
|
| Rate for Payer: Galaxy Health WC |
$459.32
|
| Rate for Payer: Global Benefits Group Commercial |
$324.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$343.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.08
|
| Rate for Payer: Multiplan Commercial |
$405.29
|
| Rate for Payer: Networks By Design Commercial |
$270.19
|
| Rate for Payer: Prime Health Services Commercial |
$459.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.80
|
| Rate for Payer: United Healthcare All Other HMO |
$197.40
|
| Rate for Payer: United Healthcare HMO Rider |
$193.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.97
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
OP
|
$540.38
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$108.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,296.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,633.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$250.98
|
| Rate for Payer: Blue Shield of California EPN |
$228.16
|
| Rate for Payer: Cash Price |
$243.17
|
| Rate for Payer: Cash Price |
$243.17
|
| Rate for Payer: Central Health Plan Commercial |
$432.30
|
| Rate for Payer: Cigna of CA HMO |
$378.27
|
| Rate for Payer: Cigna of CA PPO |
$378.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.15
|
| Rate for Payer: EPIC Health Plan Senior |
$216.15
|
| Rate for Payer: Galaxy Health WC |
$459.32
|
| Rate for Payer: Global Benefits Group Commercial |
$324.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$394.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$343.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$436.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$378.27
|
| Rate for Payer: Multiplan Commercial |
$405.29
|
| Rate for Payer: Networks By Design Commercial |
$270.19
|
| Rate for Payer: Prime Health Services Commercial |
$459.32
|
| Rate for Payer: Riverside University Health System MISP |
$216.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.80
|
| Rate for Payer: United Healthcare All Other HMO |
$197.40
|
| Rate for Payer: United Healthcare HMO Rider |
$193.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.32
|
| Rate for Payer: Vantage Medical Group Senior |
$459.32
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
|
IP
|
$60,399.47
|
|
|
Service Code
|
MSDRG 098
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$60,399.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60,399.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39,015.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54,623.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$53,712.40
|
| Rate for Payer: EPIC Health Plan Senior |
$35,808.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,552.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45,574.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43,620.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32,552.97
|
| Rate for Payer: Prime Health Services Medicare |
$34,506.15
|
| 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
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
|
IP
|
$95,058.96
|
|
|
Service Code
|
MSDRG 097
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$95,058.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$95,058.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61,404.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85,968.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$83,680.97
|
| Rate for Payer: EPIC Health Plan Senior |
$55,787.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50,715.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71,002.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67,959.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$50,715.74
|
| Rate for Payer: Prime Health Services Medicare |
$53,758.68
|
| 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
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$35,857.01
|
|
|
Service Code
|
MSDRG 099
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$35,857.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,857.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,162.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32,427.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,491.63
|
| Rate for Payer: EPIC Health Plan Senior |
$21,661.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,691.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,568.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,387.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19,691.90
|
| Rate for Payer: Prime Health Services Medicare |
$20,873.41
|
| 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
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$19,338.24
|
|
|
Service Code
|
APR-DRG 0502
|
| Min. Negotiated Rate |
$12,213.62 |
| Max. Negotiated Rate |
$19,338.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,213.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,554.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,338.24
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$11,480.88
|
|
|
Service Code
|
APR-DRG 0501
|
| Min. Negotiated Rate |
$7,251.08 |
| Max. Negotiated Rate |
$11,480.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,251.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,640.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,480.88
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$30,327.67
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$19,154.32 |
| Max. Negotiated Rate |
$30,327.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,154.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,825.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30,327.67
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$53,925.91
|
|
|
Service Code
|
APR-DRG 0504
|
| Min. Negotiated Rate |
$34,058.47 |
| Max. Negotiated Rate |
$53,925.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$34,058.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40,586.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53,925.91
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$31,137.37
|
|
|
Service Code
|
APR-DRG 3232
|
| Min. Negotiated Rate |
$19,665.71 |
| Max. Negotiated Rate |
$31,137.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,665.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,434.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,137.37
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$41,405.71
|
|
|
Service Code
|
APR-DRG 3233
|
| Min. Negotiated Rate |
$26,150.98 |
| Max. Negotiated Rate |
$41,405.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,150.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31,163.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41,405.71
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$58,008.67
|
|
|
Service Code
|
APR-DRG 3234
|
| Min. Negotiated Rate |
$36,637.06 |
| Max. Negotiated Rate |
$58,008.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$36,637.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43,659.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58,008.67
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$27,076.75
|
|
|
Service Code
|
APR-DRG 3231
|
| Min. Negotiated Rate |
$17,101.10 |
| Max. Negotiated Rate |
$27,076.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,101.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,378.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,076.75
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$63,565.83
|
|
|
Service Code
|
APR-DRG 3254
|
| Min. Negotiated Rate |
$40,146.84 |
| Max. Negotiated Rate |
$63,565.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$40,146.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47,841.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63,565.83
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$49,263.07
|
|
|
Service Code
|
APR-DRG 3253
|
| Min. Negotiated Rate |
$31,113.52 |
| Max. Negotiated Rate |
$49,263.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$31,113.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37,076.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49,263.07
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$40,515.43
|
|
|
Service Code
|
APR-DRG 3252
|
| Min. Negotiated Rate |
$25,588.69 |
| Max. Negotiated Rate |
$40,515.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,588.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30,493.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,515.43
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$33,582.60
|
|
|
Service Code
|
APR-DRG 3251
|
| Min. Negotiated Rate |
$21,210.06 |
| Max. Negotiated Rate |
$33,582.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,210.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,275.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,582.60
|
|
|
NON-EXTENSIVE BURNS
|
Facility
|
IP
|
$54,217.14
|
|
|
Service Code
|
MSDRG 935
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$54,217.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,217.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35,022.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49,032.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,366.81
|
| Rate for Payer: EPIC Health Plan Senior |
$32,244.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,313.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41,038.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39,279.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29,313.22
|
| Rate for Payer: Prime Health Services Medicare |
$31,072.01
|
| 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
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$17,726.89
|
|
|
Service Code
|
APR-DRG 7942
|
| Min. Negotiated Rate |
$11,195.93 |
| Max. Negotiated Rate |
$17,726.89 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,195.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,341.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,726.89
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$25,946.80
|
|
|
Service Code
|
APR-DRG 7943
|
| Min. Negotiated Rate |
$16,387.45 |
| Max. Negotiated Rate |
$25,946.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,387.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,528.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,946.80
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$52,052.70
|
|
|
Service Code
|
APR-DRG 7944
|
| Min. Negotiated Rate |
$32,875.39 |
| Max. Negotiated Rate |
$52,052.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$32,875.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39,176.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52,052.70
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$13,424.58
|
|
|
Service Code
|
APR-DRG 7941
|
| Min. Negotiated Rate |
$8,478.68 |
| Max. Negotiated Rate |
$13,424.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,478.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,103.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,424.58
|
|
