|
KETOROLAC 30 MG/ML INJECTION. [4082473]
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.05
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.17
|
| Rate for Payer: Heritage Provider Network Senior |
$3.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1.06
|
| Rate for Payer: Heritage Provider Network Senior |
$3.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
| Rate for Payer: Multiplan Commercial |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.60
|
|
|
KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [91349]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$20.43 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.29
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [91349]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
|
|
KETOTIFEN 0.025 % EYE DROPS [25471]
|
Facility
|
OP
|
$2.11
|
|
|
Service Code
|
NDC 7638510617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.30
|
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: Vantage Medical Group Senior |
$1.79
|
|
|
KETOTIFEN 0.025 % EYE DROPS [25471]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
NDC 7248561710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.00
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
|
|
KETOTIFEN 0.025 % EYE DROPS [25471]
|
Facility
|
IP
|
$2.11
|
|
|
Service Code
|
NDC 7638510617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.36
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
|
|
KETOTIFEN 0.025 % EYE DROPS [25471]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
NDC 7248561710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1.33
|
|
|
KETOTIFEN 0.025 % EYE DROPS [25471]
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
NDC 0536125240
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.64
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
|
|
KETOTIFEN 0.025 % EYE DROPS [25471]
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 0536125240
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.02
|
| Rate for Payer: TriValley Medical Group Senior |
$1.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.16
|
| Rate for Payer: Vantage Medical Group Senior |
$2.16
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC
|
Facility
|
IP
|
$28,802.11
|
|
|
Service Code
|
MSDRG 657
|
| Min. Negotiated Rate |
$21,494.11 |
| Max. Negotiated Rate |
$28,802.11 |
| Rate for Payer: EPIC Health Plan Medicare |
$21,494.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,494.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,718.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,802.11
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC
|
Facility
|
IP
|
$49,590.32
|
|
|
Service Code
|
MSDRG 656
|
| Min. Negotiated Rate |
$37,007.70 |
| Max. Negotiated Rate |
$49,590.32 |
| Rate for Payer: EPIC Health Plan Medicare |
$37,007.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,007.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,558.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49,590.32
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$24,530.23
|
|
|
Service Code
|
MSDRG 658
|
| Min. Negotiated Rate |
$18,306.14 |
| Max. Negotiated Rate |
$24,530.23 |
| Rate for Payer: EPIC Health Plan Medicare |
$18,306.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,306.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,052.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24,530.23
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC
|
Facility
|
IP
|
$20,996.93
|
|
|
Service Code
|
MSDRG 660
|
| Min. Negotiated Rate |
$15,669.35 |
| Max. Negotiated Rate |
$20,996.93 |
| Rate for Payer: EPIC Health Plan Medicare |
$15,669.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,669.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,019.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,996.93
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC
|
Facility
|
IP
|
$39,718.30
|
|
|
Service Code
|
MSDRG 659
|
| Min. Negotiated Rate |
$29,640.52 |
| Max. Negotiated Rate |
$39,718.30 |
| Rate for Payer: EPIC Health Plan Medicare |
$29,640.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,640.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,086.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39,718.30
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$16,600.64
|
|
|
Service Code
|
MSDRG 661
|
| Min. Negotiated Rate |
$12,388.54 |
| Max. Negotiated Rate |
$16,600.64 |
| Rate for Payer: EPIC Health Plan Medicare |
$12,388.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,388.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,246.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,600.64
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC
|
Facility
|
IP
|
$18,518.55
|
|
|
Service Code
|
MSDRG 689
|
| Min. Negotiated Rate |
$13,819.81 |
| Max. Negotiated Rate |
$18,518.55 |
| Rate for Payer: EPIC Health Plan Medicare |
$13,819.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,819.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,892.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,518.55
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$13,131.87
|
|
|
Service Code
|
MSDRG 690
|
| Min. Negotiated Rate |
$9,799.90 |
| Max. Negotiated Rate |
$13,131.87 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,799.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,799.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,269.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,131.87
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC
|
Facility
|
IP
|
$16,791.06
|
|
|
Service Code
|
MSDRG 687
|
| Min. Negotiated Rate |
$12,530.64 |
| Max. Negotiated Rate |
$16,791.06 |
| Rate for Payer: EPIC Health Plan Medicare |
$12,530.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,530.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,410.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,791.06
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC
|
Facility
|
IP
|
$28,398.24
|
|
|
Service Code
|
MSDRG 686
|
| Min. Negotiated Rate |
$21,192.72 |
| Max. Negotiated Rate |
$28,398.24 |
| Rate for Payer: EPIC Health Plan Medicare |
$21,192.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,192.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,371.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,398.24
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,837.03
|
|
|
Service Code
|
MSDRG 688
|
| Min. Negotiated Rate |
$9,579.87 |
| Max. Negotiated Rate |
$12,837.03 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,579.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,579.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,016.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,837.03
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$18,265.18
|
|
|
Service Code
|
MSDRG 695
|
| Min. Negotiated Rate |
$13,630.73 |
| Max. Negotiated Rate |
$18,265.18 |
| Rate for Payer: EPIC Health Plan Medicare |
$13,630.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,630.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,675.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,265.18
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$11,281.51
|
|
|
Service Code
|
MSDRG 696
|
| Min. Negotiated Rate |
$8,419.04 |
| Max. Negotiated Rate |
$11,281.51 |
| Rate for Payer: EPIC Health Plan Medicare |
$8,419.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,419.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,681.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,281.51
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$50,292.08
|
|
|
Service Code
|
MSDRG 652
|
| Min. Negotiated Rate |
$37,531.40 |
| Max. Negotiated Rate |
$50,292.08 |
| Rate for Payer: EPIC Health Plan Medicare |
$37,531.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,531.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43,161.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50,292.08
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC
|
Facility
|
IP
|
$72,893.78
|
|
|
Service Code
|
MSDRG 650
|
| Min. Negotiated Rate |
$54,398.34 |
| Max. Negotiated Rate |
$72,893.78 |
| Rate for Payer: EPIC Health Plan Medicare |
$54,398.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54,398.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62,558.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$72,893.78
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC
|
Facility
|
IP
|
$57,605.88
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$42,989.46 |
| Max. Negotiated Rate |
$57,605.88 |
| Rate for Payer: EPIC Health Plan Medicare |
$42,989.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42,989.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49,437.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57,605.88
|
|
