|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
|
IP
|
$26,266.36
|
|
|
Service Code
|
MSDRG 805
|
| Min. Negotiated Rate |
$5,236.00 |
| Max. Negotiated Rate |
$26,266.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,266.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,967.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,840.23
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,326.67
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,431.78
|
| Rate for Payer: EPIC Health Plan Senior |
$14,393.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,393.91
|
| Rate for Payer: InnovAge PACE Commercial |
$21,590.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,393.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,287.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,287.84
|
| Rate for Payer: Multiplan WC |
$21,326.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,393.91
|
| Rate for Payer: Preferred Health Network WC |
$21,761.91
|
| Rate for Payer: Prime Health Services Medicare |
$15,257.54
|
| Rate for Payer: Prime Health Services WC |
$21,109.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,834.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,715.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,236.00
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$16,773.10
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$5,236.00 |
| Max. Negotiated Rate |
$16,773.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,773.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,834.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,585.25
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$13,618.73
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,792.11
|
| Rate for Payer: EPIC Health Plan Senior |
$9,475.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,475.64
|
| Rate for Payer: InnovAge PACE Commercial |
$14,213.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,475.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,697.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,697.36
|
| Rate for Payer: Multiplan WC |
$13,618.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,475.64
|
| Rate for Payer: Preferred Health Network WC |
$13,896.66
|
| Rate for Payer: Prime Health Services Medicare |
$10,044.18
|
| Rate for Payer: Prime Health Services WC |
$13,479.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,834.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,715.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,236.00
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$25,482.06
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$5,236.00 |
| Max. Negotiated Rate |
$25,482.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,482.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,460.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,158.23
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$20,689.87
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,883.23
|
| Rate for Payer: EPIC Health Plan Senior |
$13,987.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,987.58
|
| Rate for Payer: InnovAge PACE Commercial |
$20,981.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,987.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,743.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,743.36
|
| Rate for Payer: Multiplan WC |
$20,689.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,987.58
|
| Rate for Payer: Preferred Health Network WC |
$21,112.11
|
| Rate for Payer: Prime Health Services Medicare |
$14,826.83
|
| Rate for Payer: Prime Health Services WC |
$20,478.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,834.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,715.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,236.00
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$33,598.84
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$5,236.00 |
| Max. Negotiated Rate |
$33,598.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,598.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21,703.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,216.27
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$27,280.19
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,560.20
|
| Rate for Payer: EPIC Health Plan Senior |
$18,192.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,192.74
|
| Rate for Payer: InnovAge PACE Commercial |
$27,289.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,192.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,378.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24,378.27
|
| Rate for Payer: Multiplan WC |
$27,280.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18,192.74
|
| Rate for Payer: Preferred Health Network WC |
$27,836.93
|
| Rate for Payer: Prime Health Services Medicare |
$19,284.30
|
| Rate for Payer: Prime Health Services WC |
$27,001.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,834.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,715.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,236.00
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$25,482.06
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$5,236.00 |
| Max. Negotiated Rate |
$25,482.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,482.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,460.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,158.23
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$20,689.87
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,883.23
|
| Rate for Payer: EPIC Health Plan Senior |
$13,987.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,987.58
|
| Rate for Payer: InnovAge PACE Commercial |
$20,981.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,987.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,743.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,743.36
|
| Rate for Payer: Multiplan WC |
$20,689.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,987.58
|
| Rate for Payer: Preferred Health Network WC |
$21,112.11
|
| Rate for Payer: Prime Health Services Medicare |
$14,826.83
|
| Rate for Payer: Prime Health Services WC |
$20,478.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,834.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,715.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,236.00
|
|
|
MS-DRG 42.00: VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$70,590.19
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$70,590.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70,590.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45,598.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61,382.54
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$57,314.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,432.36
|
| Rate for Payer: EPIC Health Plan Senior |
$37,357.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,357.30
|
| Rate for Payer: InnovAge PACE Commercial |
$56,035.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,357.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,058.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,058.78
|
| Rate for Payer: Multiplan WC |
$57,314.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37,357.30
|
| Rate for Payer: Preferred Health Network WC |
$58,484.60
|
| Rate for Payer: Prime Health Services Medicare |
$39,598.74
|
| Rate for Payer: Prime Health Services WC |
$56,730.06
|
| 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
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$56,206.86
|
|
|
Service Code
|
MSDRG 032
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$56,206.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,206.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36,307.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48,875.34
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$45,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$40,372.48
|
| Rate for Payer: EPIC Health Plan Senior |
$29,905.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,905.54
|
| Rate for Payer: InnovAge PACE Commercial |
$44,858.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,905.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,073.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,073.42
|
| Rate for Payer: Multiplan WC |
$45,636.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29,905.54
|
| Rate for Payer: Preferred Health Network WC |
$46,567.88
|
| Rate for Payer: Prime Health Services Medicare |
$31,699.87
|
| Rate for Payer: Prime Health Services WC |
$45,170.84
|
| 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
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$110,292.40
|
|
|
Service Code
|
MSDRG 031
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$110,292.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110,292.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71,244.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95,906.07
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$89,550.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$78,200.51
|
| Rate for Payer: EPIC Health Plan Senior |
$57,926.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,926.30
|
| Rate for Payer: InnovAge PACE Commercial |
$86,889.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57,926.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77,621.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77,621.24
|
| Rate for Payer: Multiplan WC |
$89,550.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$57,926.30
|
| Rate for Payer: Preferred Health Network WC |
$91,378.23
|
| Rate for Payer: Prime Health Services Medicare |
$61,401.88
|
| Rate for Payer: Prime Health Services WC |
$88,636.88
|
| 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
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$41,991.96
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$41,991.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,991.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,125.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,514.61
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$34,094.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,430.46
|
| Rate for Payer: EPIC Health Plan Senior |
$22,541.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,541.08
|
| Rate for Payer: InnovAge PACE Commercial |
$33,811.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,541.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,205.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,205.05
|
| Rate for Payer: Multiplan WC |
$34,094.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,541.08
|
| Rate for Payer: Preferred Health Network WC |
$34,790.71
|
| Rate for Payer: Prime Health Services Medicare |
$23,893.54
|
| Rate for Payer: Prime Health Services WC |
$33,746.99
|
| 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
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$38,844.21
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$38,844.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38,844.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,091.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,777.45
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$31,539.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,228.89
|
| Rate for Payer: EPIC Health Plan Senior |
$20,910.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,910.29
|
| Rate for Payer: InnovAge PACE Commercial |
$31,365.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,910.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,019.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,019.79
|
| Rate for Payer: Multiplan WC |
$31,539.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,910.29
|
| Rate for Payer: Preferred Health Network WC |
$32,182.77
|
| Rate for Payer: Prime Health Services Medicare |
$22,164.91
|
| Rate for Payer: Prime Health Services WC |
$31,217.29
|
| 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
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$23,287.05
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$23,287.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,287.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,042.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,249.53
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,907.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,348.05
|
| Rate for Payer: EPIC Health Plan Senior |
$12,850.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,850.41
|
| Rate for Payer: InnovAge PACE Commercial |
$19,275.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,850.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,219.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,219.55
|
| Rate for Payer: Multiplan WC |
$18,907.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,850.41
|
| Rate for Payer: Preferred Health Network WC |
$19,293.53
|
| Rate for Payer: Prime Health Services Medicare |
$13,621.43
|
| Rate for Payer: Prime Health Services WC |
$18,714.72
|
| 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
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$45,331.85
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$45,331.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,331.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,282.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39,418.85
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,806.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,766.39
|
| Rate for Payer: EPIC Health Plan Senior |
$24,271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,271.40
|
| Rate for Payer: InnovAge PACE Commercial |
$36,407.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,271.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,523.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,523.68
|
| Rate for Payer: Multiplan WC |
$36,806.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,271.40
|
| Rate for Payer: Preferred Health Network WC |
$37,557.83
|
| Rate for Payer: Prime Health Services Medicare |
$25,727.68
|
| Rate for Payer: Prime Health Services WC |
$36,431.10
|
| 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
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$24,131.89
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$24,131.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,131.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,588.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,984.17
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$19,593.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,938.89
|
| Rate for Payer: EPIC Health Plan Senior |
$13,288.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,288.07
|
| Rate for Payer: InnovAge PACE Commercial |
$19,932.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,288.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,806.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,806.01
|
| Rate for Payer: Multiplan WC |
$19,593.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,288.07
|
| Rate for Payer: Preferred Health Network WC |
$19,993.48
|
| Rate for Payer: Prime Health Services Medicare |
$14,085.35
|
| Rate for Payer: Prime Health Services WC |
$19,393.68
|
| 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
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$112,353.00
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$34,033.00 |
| Max. Negotiated Rate |
$112,353.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77,604.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50,129.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67,481.66
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$63,009.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,338.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40,991.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,991.11
|
| Rate for Payer: InnovAge PACE Commercial |
$61,486.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40,991.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,928.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,928.09
|
| Rate for Payer: Multiplan WC |
$63,009.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$40,991.11
|
| Rate for Payer: Preferred Health Network WC |
$64,295.77
|
| Rate for Payer: Prime Health Services Medicare |
$43,450.58
|
| Rate for Payer: Prime Health Services WC |
$62,366.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$112,353.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,905.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,147.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,033.00
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$142,148.92
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$46,778.00 |
| Max. Negotiated Rate |
$142,148.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$142,148.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91,822.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123,607.29
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$115,416.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$100,481.31
|
| Rate for Payer: EPIC Health Plan Senior |
$74,430.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74,430.60
|
| Rate for Payer: InnovAge PACE Commercial |
$111,645.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74,430.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99,737.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99,737.00
|
| Rate for Payer: Multiplan WC |
$115,416.21
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$74,430.60
|
| Rate for Payer: Preferred Health Network WC |
$117,771.64
|
| Rate for Payer: Prime Health Services Medicare |
$78,896.44
|
| Rate for Payer: Prime Health Services WC |
$114,238.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$112,353.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,223.00
|
| Rate for Payer: United Healthcare HMO Rider |
$51,058.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46,778.00
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$112,353.00
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$24,458.22 |
| Max. Negotiated Rate |
$112,353.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,692.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,515.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39,732.38
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$37,099.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,018.60
|
| Rate for Payer: EPIC Health Plan Senior |
$24,458.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,458.22
|
| Rate for Payer: InnovAge PACE Commercial |
$36,687.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,458.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,774.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,774.01
|
| Rate for Payer: Multiplan WC |
$37,099.44
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,458.22
|
| Rate for Payer: Preferred Health Network WC |
$37,856.57
|
| Rate for Payer: Prime Health Services Medicare |
$25,925.71
|
| Rate for Payer: Prime Health Services WC |
$36,720.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$112,353.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39,735.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30,180.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27,650.00
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$49,942.93
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$49,942.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,942.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32,261.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43,428.47
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$40,550.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,991.43
|
| Rate for Payer: EPIC Health Plan Senior |
$26,660.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,660.32
|
| Rate for Payer: InnovAge PACE Commercial |
$39,990.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,660.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,724.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,724.83
|
| Rate for Payer: Multiplan WC |
$40,550.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26,660.32
|
| Rate for Payer: Preferred Health Network WC |
$41,378.16
|
| Rate for Payer: Prime Health Services Medicare |
$28,259.94
|
| Rate for Payer: Prime Health Services WC |
$40,136.82
|
| 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
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$116,606.33
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$116,606.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$116,606.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75,322.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101,396.42
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$94,677.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$82,616.52
|
| Rate for Payer: EPIC Health Plan Senior |
$61,197.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61,197.42
|
| Rate for Payer: InnovAge PACE Commercial |
$91,796.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61,197.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82,004.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82,004.54
|
| Rate for Payer: Multiplan WC |
$94,677.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$61,197.42
|
| Rate for Payer: Preferred Health Network WC |
$96,609.37
|
| Rate for Payer: Prime Health Services Medicare |
$64,869.27
|
| Rate for Payer: Prime Health Services WC |
$93,711.09
|
| 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
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$32,085.49
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$32,085.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,085.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,725.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,900.32
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$26,051.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,501.76
|
| Rate for Payer: EPIC Health Plan Senior |
$17,408.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,408.71
|
| Rate for Payer: InnovAge PACE Commercial |
$26,113.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,408.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,327.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,327.67
|
| Rate for Payer: Multiplan WC |
$26,051.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,408.71
|
| Rate for Payer: Preferred Health Network WC |
$26,583.11
|
| Rate for Payer: Prime Health Services Medicare |
$18,453.23
|
| Rate for Payer: Prime Health Services WC |
$25,785.62
|
| 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
|
|
|
MUCOSITIS COCKTAIL COMPOUND [4080306]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 9408-0306-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
MUCOSITIS COCKTAIL COMPOUND [4080306]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 9408-0306-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
MUCOSITIS COCKTAIL COMPOUND [4080306]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 9408-0306-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
MUCOSITIS COCKTAIL COMPOUND [4080306]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 9408-0306-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
MUCOSITIS COCKTAIL (PINK LADY) [4080321]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 9994-0803-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: InnovAge PACE Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Riverside University Health System MISP |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
MUCOSITIS COCKTAIL (PINK LADY) [4080321]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 9994-0803-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
