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hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|CA,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,, | ||
West Mercy Hospital,July 1 2024,2.0,West Mercy Hospital|West Mercy Surgical Center,"12 Main Street, Fullerton, CA 92832|23 Ocean Ave, San Jose, CA 94088",50056,true,,,,,,,,,,,,,, | ||
Description,code|1,code|1|type,code|2,code|2|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,estimated_amount,standard_charge|methodology,standard_charge|min,standard_charge|max,additional_generic_notes | ||
Major hip and knee joint replacement or reattachment of lower extremity without mcc,470,MS-DRG,175869,LOCAL,,inpatient,,,,,Platform Health Insurance,PPO,20000,,MS-DRG,22243.34,case rate,20000,20000, | ||
Major hip and knee joint replacement or reattachment of lower extremity without mcc,470,MS-DRG,175869,LOCAL,,inpatient,,,,,Platform Health Insurance,PPO,20000,,https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/html/images/OP.jpg,22243.34,case rate,20000,20000, | ||
Major hip and knee joint replacement or reattachment of lower extremity without mcc,470,MS-DRG,175869,LOCAL,,inpatient,,,,,Platform Health Insurance,PPO,20000,,The adjusted base payment rate indicated in the standard_charge|negotiated_dollar data element may be further adjusted for additional factors including transfers and outliers.,22243.34,case rate,20000,20000, | ||
Major hip and knee joint replacement or reattachment of lower extremity without mcc,470,MS-DRG,175869,LOCAL,,inpatient,,,,,Region Health Insurance,HMO,,50,,23145.98,percent of total billed charges,20000,20000, | ||
"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",92626,CPT,,,,outpatient,,,150,125,Platform Health Insurance,PPO,98.98,,,,fee schedule,98.98,98.98,110% of the Medicare fee schedule | ||
"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",92626,CPT,,,,outpatient,,,150,125,Region Health Insurance,HMO,,115,,105.34,fee schedule,98.98,98.98,115% of the state's workers' compensation amount | ||
"Behavioral health; residential (hospital residential treatment program), without room and board, per diem",H0017,HCPCS,,,,inpatient,,,2500,2250,Platform Health Insurance,PPO,1500,,,,per diem,1500,1500, | ||
"Behavioral health; residential (hospital residential treatment program), without room and board, per diem, days 1-3",H0017,hcpcs,,,,inpatient,,,2500,2250,Region Health Insurance,HMO,2000,,,,per diem,2000,2000, | ||
"Behavioral health; residential (hospital residential treatment program), without room and board, per diem, days 4-5",H0017,HCPCS,,,,inpatient,,,2500,2250,Region Health Insurance,HMO,1800,,,,per diem,1800,1800, | ||
"Behavioral health; residential (hospital residential treatment program), without room and board, per diem, days 6+",H0017,HCPCS,,,,inpatient,,,2500,2250,Region Health Insurance,HMO,1200,,,,per diem,1200,1200, | ||
Treatment or observation room — observation room,762,RC,,,,outpatient,,,13000,12000,Platform Health Insurance,PPO,8000,,,,case rate,8000,10000,Negotiated standard charge without surgery and without rule out myocardial infarction | ||
Treatment or observation room — observation room,762,RC,,,,outpatient,,,13000,12000,Platform Health Insurance,PPO,10000,,,,case rate,8000,10000,Negotiated standard charge without surgery and with rule out myocardial infarction | ||
Treatment or observation room — observation room,762,RC,,,,outpatient,,,13000,12000,Region Health Insurance,HMO,9000,,,,case rate,8000,10000, |
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hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|CA,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,, | ||
West Mercy Hospital,2024-07-01,2.0,West Mercy Hospital|West Mercy Surgical Center,"12 Main Street, Fullerton, CA 92832|23 Ocean Ave, San Jose, CA 94088",50056,true,,,,,,,,,,,,,, | ||
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Description,code|1,code|1|type,code|2,code|2|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,estimated_amount,standard_charge|methodology,standard_charge|min,standard_charge|max,additional_generic_notes | ||
Major hip and knee joint replacement or reattachment of lower extremity without mcc,470,MS-DRG,175869,LOCAL,,inpatient,,,,,Platform Health Insurance,PPO,20000,,MS-DRG,22243.34,case rate,20000,20000, | ||
Major hip and knee joint replacement or reattachment of lower extremity without mcc,470,MS-DRG,175869,LOCAL,,inpatient,,,,,Platform Health Insurance,PPO,20000,,https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/html/images/OP.jpg,22243.34,case rate,20000,20000, | ||
Major hip and knee joint replacement or reattachment of lower extremity without mcc,470,MS-DRG,175869,LOCAL,,inpatient,,,,,Platform Health Insurance,PPO,20000,,The adjusted base payment rate indicated in the standard_charge|negotiated_dollar data element may be further adjusted for additional factors including transfers and outliers.,22243.34,case rate,20000,20000, | ||
Major hip and knee joint replacement or reattachment of lower extremity without mcc,470,MS-DRG,175869,LOCAL,,inpatient,,,,,Region Health Insurance,HMO,,50,,23145.98,percent of total billed charges,20000,20000, | ||
"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",92626,CPT,,,,outpatient,,,150,125,Platform Health Insurance,PPO,98.98,,,,fee schedule,98.98,98.98,110% of the Medicare fee schedule | ||
"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",92626,CPT,,,,outpatient,,,150,125,Region Health Insurance,HMO,,115,,105.34,fee schedule,98.98,98.98,115% of the state's workers' compensation amount | ||
"Behavioral health; residential (hospital residential treatment program), without room and board, per diem",H0017,HCPCS,,,,inpatient,,,2500,2250,Platform Health Insurance,PPO,1500,,,,per diem,1500,1500, | ||
"Behavioral health; residential (hospital residential treatment program), without room and board, per diem, days 1-3",H0017,hcpcs,,,,inpatient,,,2500,2250,Region Health Insurance,HMO,2000,,,,per diem,2000,2000, | ||
"Behavioral health; residential (hospital residential treatment program), without room and board, per diem, days 4-5",H0017,HCPCS,,,,inpatient,,,2500,2250,Region Health Insurance,HMO,1800,,,,per diem,1800,1800, | ||
"Behavioral health; residential (hospital residential treatment program), without room and board, per diem, days 6+",H0017,HCPCS,,,,inpatient,,,2500,2250,Region Health Insurance,HMO,1200,,,,per diem,1200,1200, | ||
Treatment or observation room — observation room,762,RC,,,,outpatient,,,13000,12000,Platform Health Insurance,PPO,8000,,,,case rate,8000,10000,Negotiated standard charge without surgery and without rule out myocardial infarction | ||
Treatment or observation room — observation room,762,RC,,,,outpatient,,,13000,12000,Platform Health Insurance,PPO,10000,,,,case rate,8000,10000,Negotiated standard charge without surgery and with rule out myocardial infarction | ||
Treatment or observation room — observation room,762,RC,,,,outpatient,,,13000,12000,Region Health Insurance,HMO,9000,,,,case rate,8000,10000, |
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Original file line number | Diff line number | Diff line change |
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@@ -0,0 +1,3 @@ | ||
hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|CA,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,, | ||
West Mercy Hospital,2024-07-01,2.0,West Mercy Hospital|West Mercy Surgical Center,"12 Main Street, Fullerton, CA 92832|23 Ocean Ave, San Jose, CA 94088",50056,true,,,,,,,,,,,,,, | ||
Description,code|1,code|1|type,code|2,code|2|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,estimated_amount,standard_charge|methodology,standard_charge|min,standard_charge|max,additional_generic_notes |
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